External Rotation Range Research Articles

Association of Shoulder Dysfunction with Mobility Limitation Among Older Adults in the Baltimore Longitudinal Study of Aging.

Association between lower extremity dysfunction and mobility limitation in older adults is well-established; whereas, the impact of upper extremity dysfunction on mobility remains unclear. Since lower extremity dysfunction does not explain all mechanisms that contribute to mobility limitation, more holistic hypotheses that explain reduced mobility in older populations are needed. The shoulders facilitate dynamic stability for ambulation, but the impact of shoulder dysfunction on mobility is poorly understood. This study examined the cross-sectional association of restricted shoulder elevation and external rotation range of motion (ROM) with poor lower extremity function and walking endurance capacity among 613 older adults aged 60 years and older in the Baltimore Longitudinal Study of Aging. Results showed that persons with abnormal shoulder elevation or external rotation ROM were 2.5 to 4.5 times more likely to perform poorly on the expanded Short Physical Performance Battery (p < .050) and the fast-paced 400 m walk test (p < .050), relative to participants with normal shoulder ROM. These findings provide nascent preliminary evidence that shoulder dysfunction is associated with mobility limitation and suggest that future studies are needed to clarify its impact on mobility and to develop novel interventions to improve prevention or mitigation of age-related declines in mobility.

Comparing the Efficiency of the Femoral Neck System and the Cannulated Compression Screw in Treating Femoral Neck Fractures in Patients Who Are Young and Middle-aged Indian Population

Background: There are no long-term studies regarding the clinical effectiveness of a novel fixation technique (femoral neck system [FNS]) for femoral neck fractures. The primary aim of this study was to compare the effectiveness of two internal fixation techniques (FNS and cannulated compression screw [CCS]) for treating femoral neck fractures in individuals between the ages of 20 and 40 years. Materials and Methods: Data of patients who underwent internal fixation surgery for femoral neck fractures in our hospital between January 2018 and January 2020 with CCS and between January 2020 and January 2022 with FNS were retrospectively evaluated. The groups of CCS and FNS were separated based on the various internal fixation techniques. Demographics about all patients, including sex, age, body mass index, and fracture type were recorded. Pre-operative and 1-year post-operative follow-up of patients was to assess femoral neck shortenings and the Harris Hip score was used to evaluate joint function. Post-operative complications such as femoral head necrosis, non-union, and femoral neck shortening were noted. Results: 30 patients each of CCS and FNS system fixation were enrolled in the study. The male-to-female ratio was 21:9 and 18:12 for CCS and FNS, respectively. The average age of both groups was around 30 years. Compared to patients treated with CC screws, patients who had FNS treatment required less time to recuperate and resume normal activities. The HSS score improvement at 2 weeks and 12 weeks was significantly better in the FNS system than CCS fixation. There was improvement in flexion, abduction, and external rotation range of motion in FNS compared to CCS. There was no statistically significant difference between the two groups in the incidence of femoral head necrosis or fracture non-union following surgery. Conclusion: Patients treated with FNS for femoral neck fractures in the age range of 20–40 years can achieve better hip scores than CCS fixation and also have improved range of motion in flexion, abduction, and external rotation. Keywords: Femoral neck system, cannulated cancellous screw, femoral neck fractures, harris hip score

Could the Improvement of Supraspinatus Muscle Activity Speed up Shoulder Pain Rehabilitation Outcomes in Wheelchair Basketball Players?

Shoulder pain (SP) is a common clinical complaint among wheelchair basketball (WB) players, since their shoulders are exposed to intense overload and overhead movements. The supraspinatus tendon is the most exposed to WB-related injuries and it is primarily responsible for SP in WB athletes. In these cases, SP rehabilitation remains the main treatment, but there is still a lack of specific protocols which should be customized to WB players' peculiarities and to the supraspinatus muscle activity monitor, and the improvement of rehabilitation outcomes is slow. Thus, the aim of this study was to verify if the improvement of supraspinatus muscle activity, monitored in real time with surface electromyography (sEMG) during the execution of therapeutic exercises, could speed up SP rehabilitation outcomes in WB players. Thirty-three athletes were enrolled. They were divided into two groups. Both groups underwent the same shoulder rehabilitation program, but only the Exercise Plus sEMG Biofeedback Group executed therapeutic exercises while the activity of the supraspinatus muscles was monitored using sEMG. Participants were evaluated at enrollment (T0), at the end of 4 weeks of the rehabilitation program (T1), and 8 weeks after T1 (T2), using the following outcome measures: supraspinatus muscle activity as root mean square (RMS), Wheelchair User's Shoulder Pain Index (WUSPI), shoulder abduction, and external rotation range of motion (ROM). The Exercise Plus sEMG Biofeedback Group improved more and faster for all the outcomes compared to the Exercise Group. The monitoring and improvement of supraspinatus muscle activity seems to be an effective way to speed up SP rehabilitation outcomes in WB players, since it makes the performance of therapeutic exercise more precise and finalized, obtaining better and faster results in terms of recovery of shoulder function.

Long-Term Results of Microsurgical Brachial Plexus Reconstruction in Late-Presenting Cases of Brachial Plexus Birth Injury

The role of primary surgery in delayed presenting cases of brachial plexus birth injury is still debated. The purpose of this study was to evaluate the results of brachial plexus reconstruction performed at the age of ≥12 months. Twenty-nine cases were included. Five cases had upper (C5-6) palsy, 4 had upper/middle (C5-7), and 20 had total (C5-8 and T1) palsy. The age at the time of primary surgery was an average of 15.6 months. The brachial plexus was formally explored and neurolysis, grafting, and neurotization were used in different combinations. Exploration revealed that 27% of the roots were avulsed and 32% were ruptured. The follow-up was an average of 7.9 years. Generally, the best functional recovery was elbow flexion followed by shoulder external rotation. Satisfactory shoulder abduction (≥6 on the Toronto Active Movement Scale [TAMS]) was achieved in 31% of cases. The abduction range was an average of 79° ± 35°; 50° in upper palsy, 103° in upper/middle palsy, and 82° in total palsy. Shoulder external rotation ≥6 on the TAMS was achieved in 62% of cases. External rotation range was an average of 58° ± 29°; 78° in upper palsy, 68° in upper/middle palsy, and 52° in total palsy. Elbow flexion and extension of ≥6 on the TAMS were achieved in 69% and 58% of cases, respectively. Wrist flexion and finger flexion of ≥6 on the TAMS were achieved in 35% and 12.5%, whereas wrist and finger extension of >6 on the TAMS were achieved in 25% and 4% of cases, respectively. In the delayed presentation of brachial plexus birth injury, brachial plexus reconstruction results in good functional recovery of elbow flexion and shoulder external rotation but modest functional recovery of finger flexion and wrist extension. The rate of functional recovery of the elbow flexion was similar following nerve grafting and transfer. Nerve transfer for shoulder external rotation should be considered even in infants with available roots for grafting. Therapeutic IV.

Effect of exercise on rehabilitation of breast cancer surgery patients: A systematic review and meta-analysis of randomized controlled trials.

To determine the effective exercise methods for different complications of breast cancer patients after surgery. Systematic review and meta-analysis. A comprehensive electronic search was carried out with no time limit until May 2020. Studies must have been randomized controlled trials of patients after breast cancer surgery, without limit to the way of exercise. Literature quality was evaluated by the modified Jadad scale. The meta-analysis was conducted with CMA2.0 software. Aerobic exercise reduced the intensity of the pain (MD=-1.043), improved shoulder flexion (MD=3.398) and internal rotation range (MD=3.868), lessened upper limb dysfunction (MD=-5.231) and improved muscle strength during flexion (MD=1.076) and abduction (MD=0.991). Shoulder elbow movement improved the range of shoulder external rotation (MD=2.691) and reduced the incidence of arm lymphedema (RR=0.343). Anti-resistance exercise also lessened upper limb dysfunction (MD=- 4.094).

The Effects of a Compensatory Training Program Adding an Isoinertial Device in the Shoulder Function on Young Tennis Players.

Fernandez-Fernandez, J, Moreno-Perez, V, Cools, A, Nakamura, FY, Teixeira, AS, Ellenbecker, T, Johansson, F, and Sanz-Rivas, D. The effects of a compensatory training program adding an isoinertial device in the shoulder function on young tennis players. J Strength Cond Res 37(5): 1096-1103, 2023-The aim of this study was to analyze whether a compensatory training program, including isoinertial flywheel training, could reduce shoulder imbalances in a group of asymptomatic young tennis players. After an initial evaluation, 26 young tennis players were assigned to either a supervised flywheel training group (FTG, n = 13) or a control group (CG, n = 13). Shoulder passive internal (IR) and external rotation (ER) range of motion (ROM) as well as shoulder IR and ER maximal isometric strength were measured before and after a 12-week training intervention, performed 3 times per week. After the intervention, results showed significant changes for IR ( p < 0.001, effect size [ES] = 1.83) and ER ( p < 0.001, ES = 1.77) on the dominant (D) side, and IR on the nondominant (ND) side ( p < 0.001, ES = 2.24) in the FTG compared with the CG. Regarding the ROM values, results showed that the FTG achieved significantly greater increases for the IR ROM ( p < 0.001, ES = 3.32) and total ROM (TROM) ( p = 0.004, ES = 1.39) on the D and ND sides (IR ROM: p = 0.002, ES = 1.53; TROM: p < 0.001, ES = 2.35) than the CG. Moreover, the CG displayed larger decrements in ER ROM ( p = 0.016, ES = 1.12) on the ND side after the training period than the FTG. The conducted compensatory training program was effective to increase the ER strength and IR mobility of the FTG players, which led to a reduction in the glenohumeral imbalances.

Effectiveness analysis of MAKO robotic-arm assisted total hip arthroplasty via direct anterior approach for bony fused hips

To investigate the effectiveness of MAKO robotic-arm assisted total hip arthroplasty (THA) via direct anterior approach (DAA) for bony fused hips in ankylosing spondylitis (AS). Between June 2021 and January 2022, MAKO robotic-arm assisted THA via DAA was applied to treat 10 cases (12 hips) of AS with bony fused hips. There were 7 males and 3 females; the age ranged from 30 to 71 years, with an average age of 42.4 years. The duration of AS was 12-35 years, with an average of 21.4 years. The preoperative hip was ankylosed in flexion in 3 cases, with a flexion angle of 20°, 30°, 35°, respectively; 9 cases were ankylosed in extension. The operation time and complications were recorded; the visual analogue scale (VAS) score, Harris score, and Oxford hip scale (OHS) score before and after operation, and postoperative range of motion (flexion, extension, internal rotation, external rotation, adduction, and abduction) were used to evaluate the recovery of joint function; according to the postoperative anteroposterior X-ray film and CT scan of both hip joints, the abduction angle, anteversion angle, the difference between bilateral combined off-set and the lower limb length discrepancy were measured. The operation time ranged from 80 to 190 minutes (mean, 134.6 minutes). All 10 patients were followed up 5-11 months (mean, 7.4 months). There was no serious adverse events such as incision infection, deep vein thrombosis of lower extremities, hip redislocation, aseptic loosening of the prosthesis, or death. At 5 months after operation, the acetabular prosthesis angle of abduction was 37°-45° (mean, 40.3°), anteversion angle was 9°-20° (mean, 15.8°). The difference between bilateral combined off-set was 0-10 mm (mean, 4.3 mm); the lower limb length discrepancy was 0-12 mm (mean, 3.5 mm). At last follow-up, the average range of motion of the hip joint was 89.2° in flexion (range, 80°-100°), 1.7° in extension (range, -5°-10°), 7.1° in internal rotation (range, 0°-15°), 20.4° in external rotation (range, 10°-30°), 7.9° in adduction (range, 0°-20°), and 16.5° in abduction (range, 10°-25°). At last follow-up, the VAS score, Harris score, and OHS score significantly improved when compared with those before operation ( P<0.05). The MAKO robotic-arm assisted THA via DAA can achieve satisfactory results in the treatment of AS with bony fused hip, which has the advantages of accurate prosthesis installation, soft tissue release, and less trauma during operation.

Role of middle glenohumeral ligament in external shoulder rotation

The middle glenohumeral ligament (MGHL) is one of the three ligaments that stabilize the anterior capsule of the shoulder. Recent work suggests that it inserts distally into the deep layer of the subscapularis tendon. The role of the MGHL remains debated. The hypothesis of this study was that the MGHL plays a significant functional role in limiting external rotation of the shoulder while allowing a wide range of motion through its distal insertion into the subscapularis rather than directly onto the humerus. In a cadaveric study performed on 20 shoulders (10 subjects), the MGHL and the other anterior structures of the shoulder were successively cut according to a standardized protocol. At each stage, the external rotation range of the shoulder was measured with the arm at the side (ER 1) and in 90° abduction (ER 2) using a goniometer. After dissection, the structure of the MGHL and its distal insertion were analyzed. Cutting the MGHL led to significant increases in ER 1 but not in ER 2. Shoulder range of motion in ER 1 increased on average by 15±5° (P<.001) after cutting the MGHL and by 21±11° (P<.001) after subscapularis peel. The range of motion in ER 2 increased by 3±4° (P=.048) after cutting the MGHL, by 4±6° (P=.02) after subscapularis peel and by 25±8° (P<.001) after cutting the inferior glenohumeral ligament. The MGHL was present in all dissected shoulders. It was leaf-like in 12 cases, cord-like in 6 cases and had a vestigial appearance in 2 cases. The distal insertion was in all cases in the deep layer of the subscapularis in a thickening of the anterior capsule in the superior part of the muscle, except for two cases in which the tendinous part of the subscapularis was also involved. The MGHL limited shoulder external rotation by a similar amount as the subscapularis muscle. Further studies are required to understand the clinical relevance of these findings, notably for the treatment of shoulder stiffness.

The Intra- and Inter-Rater Reliability of a Variety of Testing Methods to Measure Shoulder Range of Motion, Hand-behind-Back and External Rotation Strength in Healthy Participants.

This study determined the intra- and inter-rater reliability of various shoulder testing methods to measure flexion range of motion (ROM), hand-behind-back (HBB), and external rotation (ER) strength. Twenty-four healthy adults (mean age of 31.2 and standard deviation (SD) of 10.9 years) without shoulder or neck pathology were assessed by two examiners using standardised testing protocols to measure shoulder flexion with still photography, HBB with tape measure, and isometric ER strength in two abduction positions with a hand-held dynamometer (HHD) and novel stabilisation device. Intraclass correlation coefficient (ICC) established relative reliability. Standard error of measurement (SEM) and minimum detectable change (MDC) established absolute reliability. Differences between raters were visualised with Bland-Altman plots. A paired t-test assessed for differences between dominant and non-dominant sides. Still photography demonstrated good intra- and inter-rater reliability (ICCs 0.75-0.86). HBB with tape measure demonstrated excellent inter- and intra-rater reliability (ICCs 0.94-0.98). Isometric ER strength with HHD and a stabilisation device demonstrated excellent intra-rater and inter-rater reliability in 30° and 45° abduction (ICCs 0.96-0.98). HBB and isometric ER at 45° abduction differed significantly between dominant and non-dominant sides. Standardised shoulder ROM and strength tests provide good to excellent reliability. HBB with tape measure and isometric strength testing with HHD stabilisation are clinically acceptable.

Effect of total arthroscopic rotator cuff repair on pain degree and complications of elderly patients with rotator cuff injury within 72 hours after operation

To analyze the clinical effect of rotator cuff repair and small incision rotator cuff repair under the total arthroscopy in elderly patients with rotator cuff injury. A total of 60 elderly patients with rotator cuff injury from January 2017 to November 2018 were selected as the research objects, including 37 males and 23 females;aged from 61 to 77 years old with an average of (63.45±12.34) years old;disease duration ranged from 6 to 12 months, with an average of (5.32±1.02 ) months;29 cases on the left side and 31 cases on the right side. Among them, 30 patients underwent total arthroscopic rotator cuff repair (observation group), 30 patients underwent small-incision rotator cuff repair(control group). The scores of University of California, Los Angeles(UCLA) shoulder rating scale, before and after surgery in the two groups were observed and recorded. The American Shoulder and Elbow Surgeons(ASES) score, Constant-Murley score, shoulder flexion range of motion, external rotation range of motion, abduction range of motion, visual analogue scale(VAS) within 72 hours after surgery, as well as the complcations were compared. The postoperative UCLA score, ASES score and Constant-Murley score between two groups were significantly higher than those before operation (P<0.05). There was no significant difference in postoperative UCLA, ASES and Constant-Murley score between two groups (P>0.05). The shoulder flexion range of motion, external rotation range of motion and abduction range of motion between two groups were significantly higher than those before operation (P<0.05). There was no significant difference between the two groups after operation (P>0.05). The VAS at 24, 48 and 72 h after operation in observation group were significantly lower than those in control group (P<0.05). The total incidence of complications in observation group(13.33%, 4/30) was sinificantly lower(P<0.05)than that in control group(33.33%, 10/30). Total arthroscopic rotator cuff repair and small incision rotator cuff repair can improve the shoulder function after rotator cuff injury in elderly, but the degree of pain and complications within 72 hours after total arthroscopic rotator cuff repair are significantly better than small incision rotator cuff repair, which can be selected according to the clinical situation and needs of patients.

Decreased Expression of Leptin among Patients with Shoulder Stiffness.

Shoulder stiffness (SS) is a disease that is fibroblastic and inflammatory in nature. Leptin is an adipokine-mediating the fibroblastic and inflammatory processes of various diseases. Our study tried to investigate the role of leptin in SS pathogenesis. Subacromial bursa from stiff and non-stiff shoulders were obtained for reverse transcription-polymerase chain reaction (RT-PCR) analysis and immunoblotting. Subacromial fluid was obtained for enzyme-linked immunosorbent assay. We showed that the expression level of leptin was lower in the subacromial bursae from the stiff shoulders in RT-PCR analysis (p < 0.001) and immunoblotting (p < 0.001). The concentration of leptin was also lower in the subacromial fluid derived from stiff shoulders. The leptin level in the subacromial fluid was positively associated with the constant score, total range of motion, flexion, abduction, and external rotation. The synovial fibroblasts derived from stiff shoulder-retrieved subacromial bursa were treated by 0, 1, and 3 μM leptin. Under RT-qPCR analysis, leptin was shown to dose-dependently decrease the transcription of IL-6, IL-10, and IL-13, but without impact on IL-1β and IL-4 (p < 0.001, p = 0.001, p = 0.001, p = 0.137, and p = 0.883 by ANOVA test, respectively). These results shed light on the role of leptin in orchestrating the disease processes of SS.

How does asymmetric tibial insert affect tibiofemoral kinematics and contact stresses in total knee Arthroplasty?

BackgroundAsymmetric tibial insert design is expected to restore normal knee kinematics better than symmetric design. A tri-condylar implant has asymmetric and symmetric tibial inserts with a ball-and-socket joint to replace the post-cam mechanism. The purpose of this study was to compare the knee kinematics of the two designs and to measure tibiofemoral contact stresses, including that of the ball-and-socket joint. MethodsUsing a computer simulation, the anteroposterior position and axial rotation of the femoral component were simulated during a weight-bearing deep knee bend for six validated models. Contact forces were simultaneously simulated in the medial, lateral, and ball-and-socket compartments. The relative position and the magnitude and direction of each contact force were applied to aforce/displacement control knee simulator. The contact stresses were measured individually using a pressure sensor. ResultsThe asymmetric tibial insert demonstrated a more posterior position of the femoral component in the lateral compartment during the entire range of motion and greater external rotation of the femoral component, compared to the symmetrical tibial insert. The mean peak contact stress of the medial and lateral compartments was < 9 Mpa, with no significant differences between the two designs except at 0°. The contact stress of the ball-and-socket joint was < 5 MPa. ConclusionsAsymmetry of the tibial insert shows significant kinematic difference and has little influence on the peak contact stress, which is considerably lower than the yield strength of polyethylene. The asymmetric tibial insert can lead to clinical benefits owing to its kinematic and kinetic properties.

Surgical treatment of post-traumatic instability of the shoulder joint in athletes

BACKGROUND: Surgical treatment of post-traumatic instability of the shoulder jointinvolves the use of various surgical techniques: open Latarjet procedure, BristowLatarjet operation, which was first performed in Russia at CITO named after N.N. Priorov, the founder of the clinic for sports and ballet trauma, Professor Zoya S. Mironova, also use soft tissue stabilization with anchors, etc. However, in recent years, the Latarjet arthroscopic operation has become a priority choice in the treatment of post-traumatic instability of the shoulder joint.&#x0D; AIM: To improve the results and reduce the frequency of postoperative complications, reduce the time of surgical intervention, as well as evaluate the technical difficulties, nuances and improve the surgical technique when performing the arthroscopic Latarjet procedure in professional athletes and amateurs with post-traumatic defects of the shoulder joint.&#x0D; MATERIALS AND METHODS: During the period from 2015 to 2021, 50 Latarjet arthroscopic procedure were performed in athletes with post-traumatic defects of the glenoid cavity of the scapula.&#x0D; RESULTS: To improve postoperative results, during the Latarjet arthroscopic operation, when positioning the bone autograft, we focused on the 5 oclock in the anterior inferior section of the glenoid cavity of the scapula, which allowed us to maintain the range of motion, namely abduction, flexion and external rotation and bring it almost to the previous level in 96% of patients, the pain syndrome also regressed to 0.80.21 points. Fixation of the capsular-ligamentary apparatus exarticularly allowed to reduce the likelihood of relapse, fracture of the bone autograft, and the development of deforming osteoarthritis of the shoulder joint in the near future.&#x0D; CONCLUSIONS: The arthroscopic Latarjet procedure in the treatment of post-traumatic injuries of the shoulder joint is gaining popularity due to the fact that, using low-traumatic approaches, it is possible to correctly position the bone autograft on the anterior-inferior region of the articular surface of the scapula, without subsequent restrictions on the functional component of the shoulder joint.

Stemless versus stemmed anatomic total shoulder arthroplasty: a meta-analysis of randomized clinical studies at short term follow-up

BackgroundStemless total shoulder arthroplasty (TSA) implants were developed to counteract many of the complications and challenges associated with the stemmed humeral component. The purpose of this study was to evaluate the clinical efficacy, radiographic outcomes, and incidence of major complications of stemless implants relative to stemmed implants in the context of anatomic TSA using pooled data from randomized clinical studies. MethodsEight databases were queried in October 2021 for randomized clinical studies directly comparing the outcomes between patients treated with stemless anatomic TSA, and conventional anatomic TSA with a stemmed humeral component. Clinical outcomes between groups were compared using a random effects model and a pooled weighted mean difference, a pooled standardized mean difference, or a pooled odds ratio. ResultsFive randomized clinical studies were identified with a total of 584 patients at final follow-up (range: 24.0-32.7 months) and an average age of 64.9 years (range: 62.1-69.0 years) at the time of surgery. There was no significant difference between the 2 groups for adjusted Constant–Murley Scores (P = .20), pooled patient reported functional outcomes (P = .41), forward flexion range of motion (P = .92), external rotation range of motion (P = .05), radiographic migration/subluxation of the humeral component (P = .52), infection risk (P = .89), odds of a revision surgery (P = .86), or odds of a subsequent reverse TSA (P = .68). For odds of a periprosthetic fracture (P = .07) and odds of developing radiolucency related to the humeral component (P = .06), there was a potential clinical benefit for the stemless component; however, this difference was not statistically significant for the current data set. ConclusionThis meta-analysis directly compared stemless and stemmed anatomic TSA implants and demonstrated no significant difference in the pooled results for any of the included clinical outcomes, radiographic outcomes, major complication outcomes, or revision surgery related outcomes between the 2 groups at early follow-up, although the small sample size may preclude in finding significance. These findings suggest that there are equivalent clinical outcomes of stemless anatomic TSA components and that these implants are safe, efficacious, and non-inferior relative to the current gold standard stemmed humeral implant. The data suggest that this is true for relatively younger anatomic TSA patients sampled from a population that is similar to those included in this meta-analysis.

Effect of trochanter displacement on impingement and bone contact in total hip arthroplasty performed after curved intertrochanteric varus osteotomy for osteonecrosis of the femoral head: a simulation study

BackgroundCurved intertrochanteric varus osteotomy (CVO) is a useful treatment option for osteonecrosis of the femoral head (ONFH). However, the effect of proximal femoral deformity in cases of CVO converted to total hip arthroplasty (THA) remains unclear. The aim of this study was to evaluate the effect of trochanter displacement on impingement and the contact state of the implant and femur in THA.MethodsThirty-eight hips that had undergone CVO for ONFH were reviewed and compared with a control group of 30 contralateral hips that had not undergone surgery. The range of motion (ROM) and impingement patterns and the percentage of cortical bone in the stem placement within the femur were measured by simulation using CT-based three-dimensional template software. We also measured the ROM and the number of joints that achieved the ROM required for activities of daily living when the upward displaced apex of the greater trochanter with osteotomy was resected and compared the findings with those obtained when the apex was not resected.ResultsThe CVO group showed a significantly greater bony impingement in external rotation (68.4% vs. 43.3%, p = 0.033) and abduction (78.9% vs. 33.3%, p < 0.001) than in the control group. The CVO group showed a significantly smaller range of external rotation (19.0° [interquartile range; 4.0–28.8] vs. 38.0° [interquartile range; 36.0–41.8], p < 0.001) and abduction (23.0° [interquartile range; 8.5–38.8] vs. 56.0° [interquartile range; 50.3–60.0], p < 0.001) than in the control group. Significantly more joints achieved the ROM necessary for activities of daily living when the apex was resected than when it was not (10.5% vs. 63.2%, p < 0.001). The percentage of cortical bone in the stem placement position was significantly higher in the CVO group than in the control group in the proximal portion of the stem (25.5% vs. 0.0%, p < 0.001).ConclusionIn cases requiring conversion to THA, we recommend resecting the upward displaced apex to achieve a sufficient ROM and carefully resecting the bone to avoid malignment of the stem.

Handgrip Strength Exercises Modulate Shoulder Pain, Function, and Strength of Rotator Cuff Muscles of Patients with Primary Subacromial Impingement Syndrome.

Background Impingement syndrome was shown to be associated with shoulder pain in 44–70% of patients worldwide. It usually occurs due to imbalance and insufficient activation of the rotator cuff (RC) muscles. Aim This study explores the relative effects of handgrip-strengthening exercises on shoulder function, pain, strength, and active range of motion as part of the treatment program for the patients with primary subacromial impingement syndrome. Materials and Methods A total of 58 patients aged 18-50 years with primary subacromial impingement syndrome were randomly enrolled to participate in this single-blind randomized clinical trial. Out of them, only forty patients have eligibly matched the inclusion criteria and randomly assigned to one of two groups to undergo a standardized therapeutic program consisting of two sessions a week for 8 weeks. The control group prescribed ultrasound therapy, ice, and stretching exercises, while the experimental group followed the same program with the addition of handgrip-strengthening exercises (HGSE). Both patients of conventional therapy (control) and handgrip-strengthening exercises (experimental group) were advised to adhere also to stretching and HGSE exercises once a day at home for eight weeks. The outcomes were the shoulder function, pain intensity, muscle strength, and active range of motion of the shoulder joint. Results Patients treated with conventional interventions plus handgrip-strengthening exercises showed the significant improvement over time in shoulder pain and function, strength of rotator cuff muscles, and pain-free range of motion forward flexion, abduction, and external and internal rotation through eight weeks in the experimental group compared to control patient group treated with conventional interventions. In addition, patients of both control and experimental groups showed no significant difference in the adherence to respective home-based stretching and HGSE exercises once a day at home for eight weeks. Conclusions Adding handgrip-strengthening exercises to conventional intervention increases the efficacy of treatment for patients with primary subacromial impingement syndrome in terms of shoulder function, pain, muscle strength, and active range of motion.

Long-term results after isolated iliac wing fractures

IntroductionIsolated iliac wing fracture is a rare pelvic fracture that is considered benign in the literature. As there is a complete lack of information on function and quality of life in patients with this injury, the primary aim of this study was to evaluate the long-term functional results, and secondly to evaluate the patients’ clinical function and fracture healing. Patients and MethodsAll patients treated in Oslo University Hospital, Ullevaal (OUH-U), the Norwegian National Pelvic Service, in the time period 2006–2016 were included. Nine of 13 eligible patients (69%) were evaluated by the Patient Reported Outcome Measures (PROM); EQ-5D-3L and Majeed Score. For the secondary outcomes, the patients were clinically examined for Range of Motion (ROM) in the hips, pain, muscular function and nerve deficiencies. Finally, the patients underwent X-rays (AP-view and iliac and obturator oblique views). ResultsAll patients were injured in high-energy trauma with severe associated injuries. Five patients were operated and four received conservative treatment. At the time of follow-up (median seven years after injury), the mean EQ-5D VAS was 84, and the mean Majeed score was 87. Two out of nine reported moderate level of pain, three reported mild pain, and the rest reported no pain. Six patients were still working, two were retired, and the last one was receiving disability benefit of other reasons than the iliac fracture. One patient had difference in range of external rotation of >10° between the hips, while the rest had no differences in ROM. The follow-up X-rays showed healed fractures in all the patients. ConclusionPatients with isolated iliac wing fractures seem to have a good general state of health, scoring high on the PROMs, with minor and insignificant clinical sequela. This original finding is in accordance with the general assumption amongst pelvic surgeons that the injury is a benign one.

Bilateral glenohumeral internal rotation deficit (GIRD) in elite gymnasts

IntroductionThe “Glenohumeral Internal Rotation Deficit (GIRD)” is known as the difference in internal rotation range of motion (IRRM) between the dominant and non-dominant shoulder of overhead athletes as a result of asymmetric loading. As in contrast loading pattern in gymnastics are quite symmetric and structural changes often occur bilaterally, the question arises if GIRD might develop bilaterally in gymnasts as one source of common bilateral shoulder pathologies and to search for underlying structural adaptations.Materials and methodsA group of 35 elite gymnasts (8–24 years) were recruited from a local Olympic Training Centre and compared to a paired cohort of 28 non-overhead athletes. Clinical examinations, digital range of motion (ROM)-measurement, ultrasonographic humeral torsion measurement, and standardized MRI scans of both shoulders were obtained and examined for structural pathologies, cross-sectional areas (CSA) of the rotator cuff muscles and capsular thickness.ResultsROM-measurements showed significant decrease in IRRM in the gymnasts groups by age, with IRRM of 48.6° (SD: 8.4°, CI 95%: 43.0–54.3°) at age group 1 (8–10 years) and IRRM of 10° (SD: 11.4°; CI 95%: 0–22.0°) at age group 4 (18–26 years), that was statistically significant for the entire cohort (p = 0.017) compared to the controls. CSA were not significantly different between the cohorts, while there was a slightly increased humeral retrotorsion in the gymnasts as well as a statistically significant posterior capsular thickening.ConclusionA new bilateral form of GIRD was identified in higher age groups of youth and senior elite gymnasts enrolled in this study. Despite to former definition of GIRD there was no compensatory increase in external rotation range of motion (ERRM) but an association with posterior capsular thickening, while there was no periscapular muscle hypertrophy. Humeral retrotorsion was also slightly increased in the gymnasts group.

Glenohumeral internal rotation deficit in volleyball players with and without a history of shoulder pain

ABSTRACT This study aimed to investigate physiological and pathological Glenohumeral Internal Rotation Deficit (GIRD) in volleyball players with and without a history of shoulder pain. Volleyball players with a history of shoulder pain (n = 18) and without a history of shoulder pain (n = 18), who were matched in age, weight, height, BMI, years of experience and frequency of practice were recruited for this cross-sectional study. Shoulder internal and external rotation Range of Motion (ROM) was measured for the dominant and non-dominant shoulders of each participant using a digital inclinometer. Measurements of GIRD, External Rotation Gain (ERG), and Total Range of Motion (TROM) were calculated. There were significantly higher degrees of GIRD in the pain group (15.65⁰) than the no-pain group (9.06⁰) (p=0.004) and significantly higher differences in the TROM in the pain group (16.17⁰) than the no-pain group (10.17⁰) (p=0.007). There was no correlation between the level of pain and the presented ROM adaptations. The study showed that for volleyball players, pathological GIRD should be defined at 10-18⁰ degrees of GIRD that are accompanied by differences in the TROM that exceeds 8⁰.

Effect of Transfer Energy Capacitive and Resistive Therapy on Shoulder Pain, Disability, and Range of Motion in Patients With Adhesive Capsulitis: A Study Protocol for a Randomized Controlled Trial

ObjectiveWe describe a protocol to evaluate the effectiveness of transfer energy capacitive and resistive (TECAR) therapy on shoulder passive range of motion, shoulder pain, and disability index in patients with adhesive capsulitis. MethodsThis study will be a double-blinded randomized clinical trial with a 1-month follow-up. For the purpose of this research, 30 patients with a 3-month history of shoulder pain and disability diagnosed as adhesive capsulitis will be selected and then randomized into 2 groups, including conventional physiotherapy consisting of electrophysical modalities and therapeutic exercises, which will be given to the control group. In the intervention group, after conventional physiotherapy, 10 minutes of TECAR therapy in resistive mode will be applied on both the anterior and inferior aspects of the shoulder joint. Outcome measures will be related to shoulder passive range of abduction, flexion, and external rotation that will be measured using a digital inclinometer, as well as shoulder pain and disability index that will be assessed by the validated questionnaire. Assessment will be done at baseline, 1 day after the intervention, and by passing 1 month. ResultsThe statistical analysis will describe within-group and between-group comparisons; the findings will be illustrated in tables and charts. ConclusionGiven the reason that the effectiveness of TECAR therapy has not been widely evaluated in adhesive capsulitis, the findings of this pilot study would provide baseline information on the effectiveness and complications of this treatment method and possibly propose a more appropriate protocol for patients with adhesive capsulitis.