Chronic Shoulder Research Articles

ID: 205697 Femoral Peripheral Nerve Stimulator for Chronic Hip Pain With Total Hip Arthroplasty: A Case Report

Chronic pain is a common cause of morbidity, significantly impacting quality of life.1 As medical practice steers away from narcotic use, providers have championed for opioid-sparing techniques such as peripheral nerve stimulation for safe and effective pain management. Peripheral nerve stimulation (PNS) is a minimally invasive procedure that has been reported to be effective for pain relief while improving quality of life, with few side effects present.2,3 It has also significantly decreased the need for opioid use. PNS has been used in acute postoperative pain, and chronic shoulder, knee, and back pain.1 There is limited literature in its use for chronic hip pain, especially after surgical intervention was done for the pain. Our case involved successful implantation of a femoral PNS in a patient with chronic hip pain after total hip arthroplasty was done for his pain relief.

Primary traumatic shoulder dislocation associated with rotator cuff tear in the elderly.

Introduction and importanceThe shoulder is one of the most unstable joints of the body. Shoulder dislocation accounts for up to 60% of all major joint dislocations. This study reports two cases of primary traumatic shoulder dislocation and shows that in the elderly, primary traumatic shoulder dislocation is associated with a rotator cuff tear (RCT).Case presentationA case report and narrative review included two female patients, aged 63 and 100 years. Presenting symptoms were instability, pain, and restricted shoulder movement. Both were successfully treated by surgery. Arthroscopy was performed in the first patient and open reduction in the second patient.Clinical discussionIn the first case, we found synovitis around the rotator interval, long head of the biceps tendinitis, and tears of the subscapularis tendon, supraspinatus tendon, and subacromial bursitis. The anterior labrum was normal. In the second case, complete detachment of the infraspinatus tendon was found. In both cases, rotator cuff repair was performed. Primary traumatic shoulder dislocation in the elderly is often associated with rotator cuff injury. Therefore, a detailed evaluation and management of the rotator cuff injury is essential. Rotator cuff injuries cause loss of dynamic stabilization of the shoulder, leading to recurrent shoulder dislocation and chronic shoulder instability.ConclusionThe associated pathology of the primary traumatic shoulder dislocation in elderly are rotator cuff tear. The management of the rotator cuff tear in primary traumatic shoulder dislocation can prevent further shoulder instability events.

Manual medicine, manual therapy

AbstractManual medicine is the medical discipline that deals with diagnosis, treatment, and prevention of reversible functional disturbances in the locomotor system and other related organ systems. The current article illustrates neuroanatomical and neurophysiological fundamentals of the mechanisms of manual diagnostics and treatment. Based on the recent literature and consideration of different scientifically based clinical guidelines, the evidence-based effectiveness of manual therapeutic procedures is presented. Acute and chronic low back pain, cervicogenic headache, neck and shoulder pain, radicular arm pain, dysfunctional thoracic pain syndromes, diseases of the rotator cuff, carpal tunnel syndrome, and plantar fasciitis are included. Clinical case studies illustrate the clinical procedures. The term, the origin, and the clinical presence of “osteopathy” are addressed in detail, and the national and international societies of manual medicine (Deutsche Gesellschaft für Manuelle Medizin [DGMM], European Scientific Society of Manual Medicine [ESSOMM], Fédération Internationale de Medicine Manuelle [FIMM]) are portrayed lexically. Finally, contraindications to manual intervention are presented and an outlook on the requirements and possibilities of scientific pain analysis is given in accordance with the preamble of the Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie (GSOOC) guidelines on specific low back pain.

Allograft Reconstruction of Humeral Head Defect in Treatment of Chronic Locked Posterior Shoulder Dislocation: A Case Report

Allograft Reconstruction of Humeral Head Defect in Treatment of Chronic Locked Posterior Shoulder Dislocation: A Case Report

Osteoarticular Infection of the Shoulder Joint Due to Trichophyton Spp. in a Dog

AbstractA 10-year-old Labrador Retriever was referred for persistent lameness due to chronic right shoulder pain, unresponsive to various pain management therapies. Radiographs indicated signs of severe degenerative changes in the joint. Synovial fluid analysis was not diagnostic. Septic arthritis was suspected based on computed tomography and clinical signs. Arthroscopy allowed joint exploration, tissue biopsies, and copious joint lavage. Trichophyton spp. proliferation was identified on antimicrobial culture and histological analysis on samples obtained during arthroscopy. Oral griseofulvin therapy was initiated. Two months later, the referring veterinarian decided to interrupt the treatment after a negative synovial culture despite persistent lameness. Euthanasia was elected upon after pain also appeared on the tarsus; a post-mortem exam was not authorized by the owner. The origin of the infection remains unclear as this patient had no skin lesions and its immunological status was unknown. However, dermatophytosis has been reported in healthy dogs without skin lesions. To the author's knowledge, this is the first report of an osteoarticular infection with a dermatophyte in a dog.

Эффективность современных методик оперативного лечения передней рецидивирующей нестабильности плечевого сустава в зависимости от анатомо‑функциональных изменений

Introduction Traumatic anterior dislocation of the shoulder usually results in chronic recurrent shoulder instability, especially in young adults. To reduce the rate of recurrent dislocations, various options of osteoplastic operations have been proposed. The purpose of our study is to determine the significance of anatomical and functional disorders in patients with anterior shoulder joint instability; to evaluate the results of the methods for surgical treatment of patients with anterior recurrent instability of the shoulder joint, depending on the anatomical and functional disorders. Materials and methods The results of diagnostic examination and treatment of 169 patients with recurrent post-traumatic dislocation of the shoulder who were operated on at the Federal State Budgetary Organization “Federal Center for Traumatology, Orthopedics and Arthroplasty” (Cheboksary) were analyzed. The average age of patients was 31.1 ± 13.1 years; the average period of postoperative follow-up was 49.5 ± 24.0 months. Clinical data were assessed by angulometry, using the ROWE, ASES, UCLA, VAS scales. The size of bone defects was determined using radiological methods. 99 patients (58.6 %) underwent arthroscopic Bankart repair, 24 patients (14.2 %) with more than 15 % anterior glenoid bone defect underwent Latarjet operation. Bankart + Remplissage surgery was performed in 39 patients (23.1 %), Latarjet + Remplissage in 7 (4.1 %) patients. Results Bone defect of the glenoid of more than 15 % of the area was detected in 32 patients. Hill-Sachs grade 3 injury was reported in 24 patients. Most of these patients had a history of more than 20 dislocation episodes. Hyperelasticity of the shoulder joint was found in 34 patients. In the postoperative period, there was a slight improvement in the mean indicators of flexion and abduction in the shoulder joint from 174.2 ± 15.9° and 170.6 ± 17.8° to 175.6 ± 9.3° and 173.0 ± 12.3°, respectively. The mean external rotation worsened from 61.6 ± 25.7° to 55.9 ± 14.4°. Indicators of the ROWE, ASES, UCLA rating scales improved significantly from 38.5 ± 8.5, 76.0 ± 13.2 and 20.8 ± 3.0 to 89.9 ± 17.5, 94.0 ± 7.1 and 32.7 ± 3.7 points, respectively. Poor results were observed in 7 patients (4.1 %), of which three had a relapse. Conclusions Critically significant anatomical and functional disorders in patients with anterior instability of the shoulder joint are the defect of the anterior rim of the articular process of the scapula more than 15 %, the defect of the posterior surface of the humeral head (Hill-Sachs defect) of grade 3, hyperelasticity of the soft tissues of the shoulder joint. The severity of bone defects is directly proportional to the total number of dislocations. The effectiveness of surgical techniques for stabilizing the shoulder joint, depending on the above anatomical and functional disorders, was 95.9 %.

Immediate effects of thoracic manipulation on cervical joint position sense in individuals with mechanical neck pain: A randomized controlled trial.

Performing thoracic manipulations for neck pain can result in immediate improvements in neck function. The aim of this study was to investigate the immediate effects of thoracic manipulation on cervical joint position sense and cervical range of motion in individuals with chronic mechanical neck pain. Eighty male volunteers between 18-25 years and having chronic or recurrent neck or shoulder pain of at least 3months duration with or without arm pain were randomized into two groups: Thoracic Manipulation Group (TMG:50) and Control Group (CG:30), with a pretest-posttest experimental design. The TMG was treated with thoracic extension manipulation while the CG received no intervention. Cervical joint position error and cervical range of motion of the individuals were assessed at baseline and 5 minutes later. There was no difference in demographic variables such as age (p= 0.764), Body Mass Index (p= 0.917) and Neck Pain Disability Scale (NPDS) scores (p= 0.436) at baseline outcomes between TMG and CGs. Joint position error outcomes between the two groups following intervention were similar in all directions at 30 and 50 degrees. Differences in range of motion following intervention in neck flexion (p< 0.001) and right rotation (p= 0.004) were higher in TMG compared to CG. A single session of thoracic manipulation seems to be inefficient on joint position sense in individuals with mild mechanical neck pain. However, thoracic manipulation might be an effective option to increase flexion and rotation of the cervical region as an adjunctive to treatment.

The Split Capsule Technique for Chronic Anterior Shoulder Dislocation: A Novel Surgical Technique and Case Series

The Split Capsule Technique for Chronic Anterior Shoulder Dislocation: A Novel Surgical Technique and Case Series

Reconstruction of the Coracoacromial Ligament during a Modified Latarjet Procedure for the Treatment of Shoulder Instability: Clinical Outcome at Minimum 5 Years Follow-Up.

The function of the coracoacromial ligament (CAL) in superior shoulder stability has been well established, and the release of the CAL with the Latarjet procedure leads to increased superior humeral translation. A surgical technique was developed recently to reconstruct the CAL during a modified Latarjet procedure, and the clinical outcome of this technique at medium-term follow-up is yet to be determined. Twenty-six patients with chronic post-traumatic anterior shoulder instability were included in this retrospective case-control study. Patients in group 1 (n = 12) were surgically treated with the classic congruent-arc Latarjet, where the CAL is sacrificed. In group 2 (n = 14), the CAL was reconstructed using a pectoralis minor fascia flap (PMFF). Primary outcomes were the return to sports activity and functional assessment based on the Western Ontario Shoulder Instability Index (WOSI) and the Constant Score (CS) at minimum 5 years follow-up. Patient's demographics, sport activities, duration of surgery, the rate of recurrent dislocations, and specific complications related to the surgical technique were recorded as secondary variables. There was a decrease of the WOSI in both groups, indicating a decrease of symptoms at follow-up compared to the preoperative level. There was no statistically significant difference between groups 1 and 2 for the total WOSI as well as for all subscales. There was an increase of the CS in both groups in all four items at follow-up compared to preoperatively, indicating an increase in shoulder function at follow-up. There was a statistically significant difference between groups 1 and 2 for the total CS, as well as for the items power, mobility, and activity, but not for pain. Most patients (n = 20) returned to their preoperative sports activity, 13 at the same level. However, seven patients who used to perform their sports competitively chose to perform their activity at a noncompetitive level after the Latarjet procedure. All were younger than 35 years of age. Six patients did not return to their preoperative sports activity. All except one were over 35 years of age. The duration of surgery ranged from 75 to 125 minutes with a mean ± SD of 94.23 ± 15.06 minutes for both groups with no significant difference between the groups (p = 0.117). None of the patients had intra- or postoperative complications related to the surgical procedure. Especially, no patient had recurrent dislocations of the affected shoulder following the Latarjet procedure. The use of a PMFF is a safe technique for reconstruction of the CAL, which does not result in a longer surgery time or higher rate of complications. The reconstruction of the CAL during the modified Latarjet procedure may lead to better functional results in medium-term follow-up.

Outcomes of the Latarjet Procedure for the Treatment of Chronic Anterior Shoulder Instability Using Two Different Types of Fixation: Cortical Buttons Versus Screws

Outcomes of the Latarjet Procedure for the Treatment of Chronic Anterior Shoulder Instability Using Two Different Types of Fixation: Cortical Buttons Versus Screws

Correlation Between Chronic Neck Pain and Shoulder Proprioception Among Patients With Cervical Radiculopathy

Correlation Between Chronic Neck Pain and Shoulder Proprioception Among Patients With Cervical Radiculopathy

Correlation between acromiohumeral distance and the severity of supraspinatus tendon tear by ultrasound imaging in a Chinese population

BackgroundThe aim of this study was twofold: (i) to investigate the intrarater reliability of acromiohumeral distance measurement; (ii) to assess the level of association between acromiohumeral distance measured by ultrasonography, and the degree of supraspinatus tendon tear, in patients suffering from chronic shoulder pain.MethodsA cross-sectional, case-control study was carried out. A convenience sample comprising 59 patients with a unilateral supraspinatus tendon tear was assessed. Both shoulders of each patient were scanned by ultrasound, with the contralateral asymptomatic shoulders serving as the control group for comparison. Acromiohumeral distances of each shoulder were measured and analysed.ResultsIntrarater reliability was excellent for the ultrasound method of acromiohumeral distance measurement. The acromiohumeral distance of shoulders with full-thickness supraspinatus tendon tear was significantly smaller than that of joints with partial-thickness supraspinatus tendon tear and an intact supraspinatus tendon. There was a significant positive correlation between reduced acromiohumeral distance and the severity of a supraspinatus tendon tear.ConclusionsUltrasound is a reliable tool to measure acromiohumeral distance. A positive relationship was found between a narrowed acromiohumeral distance and the severity grading of a supraspinatus tendon tear. Reduced acromiohumeral distance can be considered a predictive parameter for a full-thickness supraspinatus tendon tear.Trial registrationThe study was prospectively registered with the Chinese Clinical Trial Registry. Registration number: ChiCTR-ROC-17013550. Date of registry: 26 November 2017.

Effectiveness of Motor Imagery Intervention for Chronic Painful Shoulder in Primary Care

Effectiveness of Motor Imagery Intervention for Chronic Painful Shoulder in Primary Care

Our First experience of Using Biodegradable Implants in Latarjet – Bristow Surgical Procedure at Chronic Posttraumatic Anterior Shoulder Insta

Background. Multi-layer spiral computed tomography shows that the main cause of shoulder instability is glenoid cavity bone defect. The aim of our research was to assess the effectiveness and safety of biodegradable implants in the treatment of patients with chronic posttraumatic anterior shoulder instability under conditions of bone defect of glenoid cavity margin by the restoration of anatomic shape and structure of scapula articular surface.Materials and methods. We performed a pilot study based on the results of surgical treatment of 7 patients using 4.5 mm biodegradable compressing screws. In preoperative period, all patients had standard two-dimensional X-rays and MSCT with 3D-reconstruction. In postoperative period, all patients had check-up X-ray right after the surgery and MRI in 3 months after the surgery.Results. The results of the treatment were assessed by common clinical criteria, functional criteria, X-ray evidence and intraand postoperative complications. We registered strong functioning of an arm and an increase in the range of motions. Data from Rowe/Zarins and DASH questionnaires showed that the patients totally recovered. X-ray evidence showed consolidation of non-free autograft to the zone of scapula bone defect without osteolysis or widening of a drilled hole. We did not observe either a failure of union, or any formation of false joint, or any screw fractures in bone tissue. Beyond that, we did not observe any complication in postoperative period and early postoperative complications in particular.Conclusion. Pilot study with use of modern biodegradable implants in osteoplastic stabilization of shoulder joint at recurring instability showed their effectiveness and safety in patients of young and active working age. However, considering small number of patients in pilot study we cannot extrapolate our results to all similar and analogue cases of using biodegradable implants. In this regard, it is necessary to perform major multicenter clinical randomized study for further long-term observation and detection of possible unwanted side effects.

Post-infectious ankylosis of the cervical spine in an army veteran: a case report

BackgroundVertebral osteomyelitis is a rare, life-threatening condition. Successful management is dependent on prompt diagnosis and management with intravenous antibiotic therapy or surgery in addition to antibiotics. Reoccurrence is minimal after 1 year. However, very little is reported in the conservative spine literature regarding the long-term follow-up and the changes to the spine following management of the spinal infection. We report the dramatic radiologic findings of the long-term sequela of a cervical spine infection following a gunshot wound from 1969. Most impressive to the spine specialist is this patient’s ability to return to work despite significant alterations to spinal biomechanics.Case presentationA 69 year-old caucasian male presented to the chiropractic clinic at a Veterans Affairs Medical Center with complaint of chronic left shoulder pain secondary to an associated full thickness tear of the left infraspinatus. An associated regional assessment of the cervical spine ensued. Radiological imaging on file revealed ankylosis C2/C3 to C7/T1. The patient reported a history of multiple fragment wounds in 1969 to the left anterior neck and shoulder 45 years earlier. Osteomyelitis of the cervical spine resulted from the wounds.ConclusionPotential sequela of osteomyelitis is ankylosis of affected joints. In this particular case, imaging provides evidence of regional ankylosis of the cervical spine. Considering the patient did not complain of cervical pain or related symptoms apart from lack of cervical range of motion, and his Neck Disability Index score was 2 out of 50 (4%), no intervention was provided to the cervical spine. The patient reported he self-managed well, worked full-time as a postal worker after he was discharged due to the injury to his neck, and planned to retire in less than one month at age 70. The patient demonstrates successful return to work with pending retirement at age 70 following spondylodiscitis and subsequent ankylosis of the cervical region.

Arthroscopic Surgery and Rehabilitation Guidelines of Shoulder Injuries in the Young Overhead Athletes

Research background and hypothesis. Overhead athletes are at higher risk to suffer from acute and chronic shoulder injuries.Research aim was to evaluate shoulder complex functional characteristics of the overhead and non-overhead young athletes before and two years after the concomitant arthroscopic type II superior labrum anterior posterior (SLAP) and partial – thickness rotator cuff (PTRC) repair and to present specific rehabilitation guidelines needed for successful return to sports.Research methods. The sample of the research included 38 male athletes: overhead (n = 19) and non-overhead (n = 19) athletes. All participants underwent concomitant arthroscopic type II SLAP and PTRC repair and were available for review at a minimum of two years after surgery. Shoulder range of motion was measured with goniometer. Constant score was used for the evaluation of the shoulder functional quality.Research results. Function of the shoulder complex had higher increase in non-overhead group (p &lt; 0.05). Constant score two years after surgery did not return to optimal level. Shoulder flexion and internal rotation ROM in both groups and external rotation ROM of non-overhead athletes were the same as before surgery.Discussion and conclusions. Functional characteristics of shoulder complex measured with Constant score of overhead and non-overhead athletes statistically significantly increased two years after the arthroscopic surgery. Significant change of external rotation was established in overhead athletes: two years after surgery it was significantly smaller and did not return even to preoperative level. Sports specific and diagnose-based rehabilitation is needed to decrease deficit in function of the shoulder complex after concomitant arthroscopic type II SLAP and PTRC repair.Keywords: shoulder complex, SLAP, partial-thickness rotator cuff tears, sports physical therapy.

Muscle Activity During a Single Set of Resistance Training to Failure in Women With Chronic Neck and Shoulder Pain Before and After 10 Weeks Training

Muscle Activity During a Single Set of Resistance Training to Failure in Women With Chronic Neck and Shoulder Pain Before and After 10 Weeks Training

Treatment of chronic back pain using indirect vibroacoustic therapy: A pilot study.

Low frequency sound wave stimulation therapy has become increasingly popular in the rehabilitation fields, due to its ease, less fatiguing and time efficient application. This 12-week pilot study examines the efficacy of applying low frequency sound wave stimulation (between 16-160 Hz) through both hands and feet on relieving pain and improving functional ability in patients with chronic back pain. Twenty-three participants with chronic shoulder (eleven participants) or low back pain (twelve participants) underwent a 12-week vibration therapy program of three sessions per week. A low frequency sound wave device comprising four piezoelectric vibration-type tactile tranducers enclosed in separate 5-cm diameter circular plates, which generate sinusoidal vibratory stimuli at a frequency of 16-160 Hz, was used in this study. Primary outcome measure was pain sensation measured using the Visual Analogue Scale (P-VAS). The secondary outcome measures were pain-related disability measured using the pain disability index (PDI) and quality of life measured using the SF-12. At week 12, significant reductions in pain sensation and pain-related disability were observed, with mean reductions of 3.5 points in P-VAS and 13.5 points in the PDI scores. Sixty-five percent of the participants had a reduction of at least 3 points on the P-VAS score, while 52% participants showed a decrease of at least 10 points in the PDI score. Significant improvement was observed in the SF-12 physical composite score but not the mental composite score. The preliminary findings showed that passive application of low frequency sound wave stimulation therapy through both hands and feet was effective in alleviating pain and improving functional ability in patients with chronic back pain.

Treatment of Chronic Temporomandibular Joint Pain and Sleep Disordered Breathing by Teledontic and Telegnathic Protocol Utilizing Total Joint Replacement

Orthopedic clinicians frequently encounter patients with temporomandibular joint (TMJ) pain and associated sleep disordered breathing (SDB) that coexists with the patient’s orthopedic conditions. The systemic effects and associated comorbidities caused by TMJ and associated SDB are commonly not recognized as potential contributors to the patient’s long-term orthopedic outcome. This article describes a comprehensive and interdisciplinary medical dental treatment, which was able to successfully address patient’s severe chronic TMJ, head, neck and shoulder pain as well as other health concerns including SDB. Moreover, a new teledontic and telegnathic treatment protocol and principles utilizing total joint replacement for care of patients with chronic TMJ pain and SDB will be introduced describing a completed case.

Identification of a Progressively Worsening Cardiac Condition in a Patient Seen in a Home Health Care Environment

The patient was a 53 year-old woman who was seen by a home health physical therapist following a lumbar spinal fusion revision surgery which was performed 2 weeks prior. In addition to low back pain, the patient had chronic bilateral shoulder, left upper extremity, chest, mid-back, and lower extremity pain and required moderate assistance for transfers, ambulation and activities of daily living with routine complaints of shortness of breath, lightheadedness, and fatigue. Due to concern over a progressively worsening cardiac condition, the physical therapist immediately consulted a cardiologist, who agreed to see the patient the next day. The patient was subsequently diagnosed with severe coronary artery disease and was treated with coronary artery bypass grafting, after which she was independent with all activities of daily living with only minimal complaints of low back pain.