Shoulder Function Research Articles

Endoprosthetic Reconstruction for Proximal Humerus Tumors.

Anatomic and reverse endoprosthetic reconstruction are two common surgical options used after tumor resection of the proximal humerus. The purpose of this article is to provide an overview of the functional outcomes and complications of modern anatomic and reverse endoprostheses. The anatomic endoprosthesis has traditionally been a successful reconstructive technique as it provided a stable platform upon which the hand and elbow could function. However, the reverse endoprosthesis has gradually replaced the anatomic endoprosthesis given that its semi-constrained design affords greater stability. Patients with reverse endoprostheses have improved motion, patient-reported outcome scores, and revision-free implant survivorship compared to those with anatomic endoprostheses. Shoulder function may be further improved with a reverse allograft prosthetic composite (APC) due to reconstruction of the rotator cuff tendons or by transferring the latissimus dorsi and teres major tendons to recreate the function of the posterosuperior rotator cuff muscles. The short-term functional improvement observed with the use of an allograft reconstruction, however, may diminish with longer follow-up due to delayed graft complications, such as resorption, nonunion, and fracture. In most patients undergoing oncologic resection of the proximal humerus, the reverse endoprosthesis or reverse APC is recommended due to improved functional outcomes and reduced postoperative complications compared to other reconstructive techniques.

Results of the Nerve Transfers and Secondary Procedures to Restore Shoulder and Elbow Function in Traumatic Upper Brachial Plexus Palsy

Results of the Nerve Transfers and Secondary Procedures to Restore Shoulder and Elbow Function in Traumatic Upper Brachial Plexus Palsy

Arthroscopic Superior Capsular Reconstruction with Acellular Human Dermal Allograft for Irreparable Rotator Cuff Tears: Outcomes, Complications, and Reoperations at 2-Year Minimum Follow-up

BackgroundManagement of posterosuperior irreparable rotator cuff tears (IRCTs) remains challenging without clear consensus amongst shoulder surgeons. Arthroscopic superior capsular reconstruction (SCR) with dermal allograft has been proposed as a promising treatment option. However, current investigations are limited to short term studies and recent data has suggested variable clinical outcomes. Therefore, the purpose of this investigation was to report intermediate-term clinical outcomes in patients who underwent arthroscopic SCR with a dermal allograft for IRCTs. MethodsOver a four-year period (2016 to 2020), all patients who underwent an arthroscopic dermal allograft SCR with a minimum two-year follow-up period were identified. SCR with dermal allograft was performed for patients with an IRCT utilizing a 3mm acellular dermal allograft. Collected clinical outcomes included range of motion (ROM), strength, Numeric Rating Scale (NRS) for pain, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Single Assessment Numeric Evaluation (SANE) score, complications, and reoperations. ResultsThe final cohort included 41 dermal allograft SCR performed in 40 patients (one bilateral) with a majority male cohort (n = 29; 72%), a mean age of 67 ± 7 years, BMI of 28.4 ± 5.0, and follow-up of 5.3 ± 1.4 years. Clinically, there was a significant improvement in pre- and post-operative NRS pain scores from 5.0 to 1.8 (P < .001), but no differences in pre- and post-operative forward flexion (P = .268), abduction (P = .822), external rotation (P = .323), or internal rotation (P = .995). The final post-operative ASES and SANE scores were 66 ± 28 and 59 ± 30, respectively. There were 8 (19.5%) complications, which consisted primarily of symptomatic graft failure in 6 (14.6%) shoulders and progression of rotator cuff arthropathy in 2 (4.9%) shoulders. Reoperations occurred in 6 (14.3%) shoulders: 4 (9.8%) were conversion to rTSA and 2 (4.9%) were arthroscopic revision dermal allograft SCR with partial repair and reattachment of the torn graft. ConclusionAt a cohort mean of five years after arthroscopic superior capsular reconstruction with dermal allograft for irreparable rotator cuff tears, patients experienced sustained pain relief but no significant improvement in shoulder function. Additionally, 20% sustained a postoperative complication with a 14% reoperation rate. These findings should be considered when counseling patients about the challenges of managing IRCTs and the possible outcomes of utilizing dermal allograft SCR as a surgical modality.

Impact of transdermal buprenorphine patch combined with celecoxib on improving shoulder pain and function of patients with primary adhesive shoulder capsulitis

BackgroundOne of the main purposes of clinical treatment for adhesive shoulder capsulitis is pain relief. However, patients often fail to achieve a satisfactory therapeutic response. This study aims to evaluate the impact of a combination therapy involving buprenorphine transdermal patch and celecoxib capsules on improving shoulder pain and function of patients with primary adhesive shoulder capsulitis (ASC).MethodsThis retrospective observational study consecutively enrolled patients with primary ASC from our hospital Outpatient Department between April 2018 and June 2020. The primary outcome was pain evaluated using the visual analog scale (VAS) score. Secondary outcomes included functional improvement evaluated using the Constant-Murley Shoulder (CMS) score, as well as satisfaction and adverse reactions.ResultsA total of 198 patients were enrolled and categorized into the celecoxib capsule group (n = 72), buprenorphine transdermal patch group (n = 65), and buprenorphine transdermal patch + celecoxib capsule group (n = 61). Patients treated with buprenorphine transdermal patch + celecoxib capsule have the lowest VAS scores and highest CMS scores at 1, 4, 8 and 12 weeks after treatment (all P < 0.001). Furthermore, there were no significant differences in adverse reactions (P = 0.296) among the three groups. The satisfaction of patient with percutaneous buprenorphine transdermal patch + celecoxib capsule was significantly higher than patients with celecoxib capsules or percutaneous buprenorphine transdermal patch (both P < 0.001).ConclusionThe combination of buprenorphine transdermal patch with celecoxib capsule may result in good analgesic efficacy and functional improvement in patients with primary ASC.Trial registrationNot applicable.

Endoscopic-Assisted Latissimus Dorsi Muscle Flap for Chest Wall Reconstruction in Poland Syndrome: Clinical Application and Literature Review.

Poland syndrome is a rare congenital chest wall developmental defect. Traditional reconstruction applies open to harvest of the latissimus dorsi muscle flap, but issues like large incisions and high complication rates exist. Endoscopic-assisted harvest of the latissimus dorsi muscle flap has minimally invasive advantages worth exploring for application in Poland syndrome patients. We retrospectively analyzed the surgical situations of five Poland syndrome patients at our center, and systematically searched the literature, including 31 cases of endoscopic-assisted latissimus dorsi muscle flap reconstruction. Data on surgical complications, postoperative shoulder function scores, aesthetic scores, and patient satisfaction were collected and comprehensively analyzed in combination with literature reports. Endoscopic surgery had smaller incisions, fewer complications, shorter recovery time, and high patient scar satisfaction. Postoperative aesthetic results were good, but the obtained flap tissue volume was limited. Upper limb function at the donor site was preserved, but there was some degree of strength decline. Endoscopic-assisted latissimus dorsi flap surgery (ELDM) allows for clear visualization of the surgical field, reduces complications, minimizes scarring, shortens recovery time, and provides better cosmetic results, making it suitable for young Poland syndrome patients seeking improved aesthetic outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Outcome of Frozen Shoulder Mobilization Under General Anesthesia

Background: Frozen shoulder, or adhesive capsulitis, is a common musculoskeletal disorder characterized by pain and restricted shoulder movement. It significantly impacts daily activities and can be associated with systemic conditions such as diabetes and thyroid disorders. While conservative treatments like physical therapy and corticosteroid injections are commonly used, mobilization under general anesthesia (MUA) is an effective alternative for patients unresponsive to these methods. However, the efficacy and long-term outcomes of MUA remain debated. Objective: This study aims to evaluate the outcomes of MUA for the treatment of frozen shoulder, specifically examining improvements in pain, shoulder function, and quality of life, as well as the factors influencing treatment success. Methods: A retrospective cohort study was conducted involving 65 patients who underwent MUA for frozen shoulder at a tertiary care hospital in Dhaka, Bangladesh, between January 2023 and January 2024. Demographic and clinical characteristics were recorded, including comorbidities and prior treatments. Patients' pre- and post-procedure pain and functional outcomes were assessed using validated tools such as the Shoulder Pain and Disability Index (SPADI), Oxford Shoulder Score (OSS), and Numeric Rating Scale (NRS). Postoperative satisfaction and complications were also documented. Results: The mean age of patients was 57.6 years, with 61.2% being female. Pre-procedure shoulder mobility assessments showed significant restrictions, including an average anteflexion of 106°, abduction of 105°, and external rotation of 24°. Post-MUA, 84% of patients reported significant pain relief, and 90% experienced improvement in daily life functioning. The median SPADI, OSS, and EQ-5D scores all indicated substantial improvement in pain, disability, and quality of life. No complications were reported, and 83.7% of patients reported sustained benefits from MUA. Conclusion: MUA is an effective treatment ..

Which patient level factors predict persistent pain after reverse total shoulder arthroplasty?

BackgroundReverse total shoulder arthroplasty (RTSA) is commonly performed to reduce pain and restore shoulder function in patients with severe shoulder conditions. While most patients experience significant pain relief and functional improvement following surgery, a subset of patients continue to report persistent pain even two years postoperatively. The aim of this study was to identify both modifiable and non-modifiable preoperative factors that contribute to the risk of persistent postsurgical pain after RTSA. By understanding these factors, clinicians can better anticipate which patients are at higher risk and develop tailored preoperative and postoperative pain management strategies to improve overall outcomes.MethodsIn this retrospective cohort study, 703 patients with complete data undergoing primary RTSA performed between 2011 and 2022 were analyzed. Persistent postsurgical pain was defined as a pain score ≥ 3 on a numeric rating scale. Multivariable regression models were used to identify patient-related and disease-related predictors of persistent postsurgical pain.ResultsThe cohort comprised 445 women (63%) and 258 men (37%) with a mean age of 74 ± 8 years at the time of surgery. Persistent postsurgical pain was reported by 18% of patients. Preoperative pain scores averaged 6.0 ± 2.5 on the NRS scale, which decreased to 1.2 ± 1.8 postoperatively. Key predictors included higher preoperative pain levels (β = 0.10, p < 0.001), worse preoperative QuickDASH scores (β = 0.09, p = 0.002), mild symptoms of anxiety or depression (β = 0.52, p = 0.001), prior contralateral TSA surgery (β = 0.34, p = 0.018) and greater number of previous ipsilateral shoulder surgeries (β = 0.44, p < 0.001). In contrast, patients with rheumatoid arthritis (β = − 0.85, p < 0.001) or primary osteoarthritis (β = − 0.82, p < 0.001) experienced lower pain levels.ConclusionOur study offers important insights into the predictors of persistent postsurgical pain two years after RTSA. Key factors, including higher preoperative pain scores, poor mental health, elevated QuickDASH scores, prior contralateral TSA surgery and a history of prior ipsilateral shoulder surgeries, were identified as significant risk indicators for persistent postsurgical pain.

The Survival, Mechanisms of Failure, and Function After Total Humeral Replacement in Patients with Primary Sarcomas

BackgroundTotal humeral replacement (THR) is one of the few options for reconstruction when the humerus is extensively involved or with skip lesions. However, there are few studies focusing on the long-term outcomes of THR for primary sarcomas, and the function and endoprosthesis survival remains uncertain. Questions/purposesThe purposes of this study were to answer the following questions: 1) What are the oncological and functional outcomes of total humeral replacement? 2) What are the overall survival and revision-free survival rates of total humeral replacement? 3) What are the failure mechanisms of total humeral replacement? MethodsA retrospective cohort study was conducted on 34 patients (22 males, 12 females) between January 1997 and December 2021. The average age was 30.1 ± 20.1 years (7 to 72) and the pathological type included osteosarcoma (24), chondrosarcoma (6), Ewing’s sarcoma (2) and undifferentiated pleomorphic sarcoma (UPS, 2). The oncological outcomes included local recurrence, metastasis, and overall survival. The functional outcomes were assessed by the Musculoskeletal Tumor Society Score (MSTS-93), the Toronto Extremity Salvage Score (TESS) , the American Shoulder and Elbow Surgeons (ASES) score and the range of motion (ROM) of the shoulder. All modes of failure were recorded in the follow-up. The significance level was adjusted to 0.025 after Bonferroni correction. ResultsThe mean follow-up of all patients was 78.5 ± 72.6 months (range, 9 to 292 months) and 103 ± 71.6 months (range, 32 to 292 months) in all survivors. Fourteen patients (41.7%) died in the last follow-up. The 5-year, 10-year, and 15-year overall survival rate of the endoprosthesis was 94% (95% CI 66.6%-99.1%). The average MSTS-93 score was 78% (range, 53% to 86%), the average TESS was 80% (60% to 90%) and the average ASES was 79% (63% to 93%), respectively. The most common failure mechanisms were tumor progression (type 5, 17.6%, 6/34), followed by soft tissue failure (type 1, 14.7%, 5/34), and structural failure (type 3, 2.9%, 1/34). ConclusionsTHR is a long-term reconstructive option for patients with massive tumors requiring complete resection of the humerus. The most common failure mechanisms were tumor progression (type 5) and soft tissue failure (type 1). Overall functional outcomes were acceptable with good hand and elbow function, but shoulder function was limited.

Factors Influencing Outcome After Shoulder Arthroplasty (FINOSA Study): Protocol of a Prospective Longitudinal Study With Randomized Group Allocation.

There is an increasing need for evidence-based postoperative rehabilitation strategies to optimize patient outcome. Knowledge of potential prognostic factors could steer the development of rehabilitation protocols and could result in better treatment outcomes and higher patient satisfaction. This study aimed to investigate which potential prognostic factors predict baseline shoulder pain and function and its evolution in the first 2 years following surgery, in patients with total shoulder arthroplasty. The secondary objective is to investigate which potential prognostic factors predict baseline quality of life and its evolution in the first two years following surgery. To reach the aims of this project, a prospective longitudinal study, running from January 2020 to March 2025, will be carried out with a follow-up of 48 months. Patients will be randomized based on sling wear. We will study factors such as shoulder function, patient expectations, psychosocial factors, lifestyle factors, sling wear, soft tissue integrity, and physiotherapy treatment. Test moments will take place preoperatively, at 6 weeks, 12 weeks, 6 months, 12 months, and 24 months. Descriptive statistics will be used to describe the patient population characteristics. Based on literature review, expert opinion, and univariate analyses, potential prognostic factors will be chosen as covariates. A mixed regression model for repeated measures will be used to assess both the evolution of the Shoulder Pain and Disability Index within persons from baseline over time and the differences in evolution between participants. Correlation analyses will be used to investigate associations between the other outcome measures such as the Constant and Murley Score, shoulder range of motion, shoulder muscle strength, and proprioception, and the primary outcome measure, the Shoulder Pain and Disability Index score. Potential prognostic factors not included in the model will be presented in a descriptive manner. Data collection started in January 2020. In April 2023 the sample size was reached. Data collection will end in April 2025. Analyses will follow when data collection is completed. Knowledge of potential prognostic factors will have implications toward better rehabilitation strategies of patients after total shoulder arthroplasty. ClinicalTrials.gov NCT04258267; https://clinicaltrials.gov/study/NCT04258267. DERR1-10.2196/56522.

Types of Injuries and the Severity of Shoulder Dysfunction Associated with Diabetes Mellitus in Patients with Functional Impairment: A Case-Control Study.

Patients with diabetes have been reported to experience a higher prevalence of shoulder disorders compared to those without diabetes or with other medical conditions. However, the specific types of shoulder injuries and the extent of functional impairment associated with diabetes mellitus remain unclear. This study aimed to assess the association between diabetes and specific shoulder injuries, as well as the degree of functional impairment in affected patients. A case-control study was conducted involving 136 patients with shoulder functional impairment (UCLA Shoulder Scale ≤ 27). The study included 38 patients with diabetes and 98 non-diabetic controls. Shoulder injuries were diagnosed using ultrasonography, focusing on the supraspinatus tendon, long head of the biceps tendon, subscapularis tendon, and the presence of adhesive capsulitis or rotator cuff tears. Diabetic patients had significantly higher rates of poor shoulder function compared to non-diabetic controls (89.47% vs. 63.26%, adjusted OR [adOR] 5.22, 95% CI 1.57-17.32, p = 0.007). While both groups had high rates of supraspinatus and long head of the biceps tendon injuries (~80%), no significant differences were found between them (p > 0.300). However, diabetic patients were more than three times as likely to have subscapularis tendon injuries (adOR 3.15, 95% CI 1.26-7.90, p = 0.014) and massive rotator cuff tears (adOR 3.76, 95% CI 1.16-12.15, p = 0.027). Additionally, diabetes was associated with a fourfold increased risk of adhesive capsulitis (adOR 4.16, 95% CI 1.20-14.47, p = 0.025). Diabetes mellitus is linked to greater functional and structural deterioration of the shoulder, highlighting the importance of considering diabetes as a risk factor for specific shoulder injuries. Early diagnosis and treatment may improve outcomes for diabetic patients with shoulder disorders.

Lower trapezius transfer to infraspinatus in cases of sequelae of obstetric brachial plexus injury

BackgroundDeficient shoulder function is a common and exhausting issue in children with obstetric brachial plexus injuries. Even with functioning elbow, wrist, and fingers, upper limb function is markedly disabled by limited shoulder abduction external rotation. Lower trapezius transfer carries many advantages; simple and safe technique, same line of pull as donor; reliable nerve supply (extraplexal from spinal accessory nerve), and not acting on rotation of the shoulder, mostly it will not adversely affect internal rotation range after the transfer. This study aims to evaluate the role of isolated lower trapezius transfer in reconstructing shoulder external rotation.Materials and methodsThis prospective case series study included 20 patients with sequelae of obstetric brachial plexus injury lacking shoulder external rotation who underwent lower trapezius transfer to infraspinatus. In all cases, the lower trapezius muscle was the donor, and the recipient tendon was the Infraspinatus muscle. Shoulder range of motion, Modified Gilbert grading, and Mallet Classification were used to evaluate results.ResultsThe mean age at the time of surgery was 4.5 years. The average increase in shoulder external rotation and abduction was 40⁰ and 42.5⁰ respectively, the modified Gilbert grading improved from a mean of 3.85 to 4.85 postoperative. Mallet classification improved from a mean of 3.5 preoperative to 4.8 postoperative. Improvement (Mallet classification of ≥ 4) was obtained in 18 cases (90%).ConclusionIsolated lower trapezius transfer is considered an effective option with promising results in cases of sequelae of obstetric brachial plexus injury for restoration of shoulder external rotation as well as abduction.

"Surviving the dip" after subacromial balloon spacer implantation for massive rotator cuff tear treatment: a retrospective case series.

Subacromial balloon spacer implantation (SBSI) attempts to decrease glenohumeral joint (GHJ) pain and improve function in patients with an irreparable rotator cuff tear (RCT) and minimal osteoarthritis. Between 12 and 26 weeks post-SBSI, gradual implant resorption may create a "balloon dip" that decreases GHJ function and increases pain. This retrospective cohort study attempted to delineate shoulder function, active mobility, strength, pain, and functional task impairment during the "balloon dip" period. Sixty-five consecutive patients (55.9 ± 7years of age, 42 men) with an irreparable RCT treated by the same fellowship-trained shoulder surgeon participated in this study. Outcome measurements pre-SBSI, during Phase I (early pain control ≤ 3weeks post-SBSI), Phase II (early rehabilitation > 3-11weeks post-SBSI), Phase III (advanced rehabilitation-early balloon resorption > 11-16weeks post-SBSI), Phase IV (early strength training > 16-24weeks post-SBSI), and Phase V (advanced strength training > 24weeks post-SBSI) included the American Shoulder and Elbow Society (ASES) score for perceived bilateral shoulder function, visual analog scale (VAS) surgical shoulder pain score, active mobility, and shoulder manual muscle strength testing (p ≤ 0.05). The mean final follow-up time was 40weeks (range = 24.1-89.7weeks). The surgical shoulder had higher ASES scores at Phase V than pre-SBSI. Surgical shoulder pain was less during Phase V than pre-SBSI. The surgical shoulder had greater flexion during Phase V than at Phase II or pre-SBSI, and greater external rotation (adducted) during Phases V-III than pre-SBSI. Peak shoulder internal rotation to level 12 (thoracic spinous process #10) occurred during Phase V. Peak shoulder flexor, external rotator, and internal rotator strength occurred during Phase V. During Phase I, most subjects were unable to sleep on their surgical shoulder, wash their back/do up their bra, reach a high shelf, or lift 10-lbs overhead. Tasks that were impaired during the "balloon dip" (between Phase III and V) were lifting 10-lbs overhead, reaching a high shelf, and doing normal work. By the end of Phase V, however, most subjects could perform each task with minimal or no difficulty. Surgical shoulder function improved and pain decreased, however, specific perceived functional task impairments remained. During the "balloon dip" phase, the perceived ability to lift 10 lbs above shoulder level, to reach a high shelf, and to do usual work activities were the most impaired tasks.

Satisfactory Clinical Outcomes After Latissimus Dorsi Tendon Transfer for Irreparable Posterosuperior Massive Rotator Cuff Tears: A 10- to 20-Year Follow-up

Background: Latissimus dorsi tendon transfer (LDTT) leads to good clinical outcomes and recovery of function. A previous study have evaluated the outcomes of LDTT at a minimum 10-year follow-up and found durable improvements in shoulder function and pain relief but observed that shoulders with fatty infiltration of the teres minor muscle and insufficiency of the subscapularis muscle tended to have inferior results. Purpose: To evaluate the outcomes of LDTT with a minimum follow-up of 10 years in a sizeable cohort for the treatment of irreparable posterosuperior massive rotator cuff tears (mRCTs). Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent LDTT for irreparable mRCTs between 2004 and 2013, performed by the same senior surgeon, were included in this study. All intraoperative and postoperative complications, as well as whether patients required conversion to reverse shoulder arthroplasty (RSA), were noted. At a minimum follow-up of 10 years, an independent observer collected range of motion measurements and clinical scores, including those for the Constant score, the Subjective Shoulder Value, and a visual analog scale for pain; the subacromial space was also assessed. Results: A total of 143 patients (147 shoulders) that underwent LDTT, with a minimum follow-up of 10 years, were included; of these, 24 patients (24 shoulders, 16%) were lost to follow-up, 1 patient (1 shoulder, 0.7%) died 9 years after the index procedure for reasons unrelated to shoulder surgery, and 18 patients (18 shoulders, 12%) required conversion to RSA, of which 6 underwent conversion at ≥6 years after LDTT. The remaining 101 patients (104 shoulders), including 3 patients who were scheduled to undergo RSA, were assessed at a mean time of 12.3 ± 2.2 years (range, 10-20 years) after index LDTT, comprised 52 men (53 shoulders) and 49 women (51 women) and had a mean age of 61.6 ± 8.0 years (range, 39-81 years) at the time of index surgery. Complications were noted in 14 shoulders, of which 4 required a reoperation. The Constant score improved by 34.2 ± 11.7 points, the adjusted Constant score by 43.5 ± 15.3 points, and the Subjective Shoulder Value score by 50.4 ± 16.4 points. The subacromial space decreased by 0.3 ± 2.0 mm. Conclusion: At a minimum follow-up of 10 years, LDTT for the treatment of irreparable posterosuperior mRCTs led to satisfactory clinical scores. Of the 147 shoulders that underwent LDTT, 18 (12%) required conversion to RSA.

Clinical Outcome and Quality of Life after Modular Reverse Total Shoulder Arthroplasty in Comparison with Joint-Preserving Locking Plate Osteosynthesis in Aged Patients: A Retrospective Comparison Study.

Proximal humeral fractures (PHFs) show a high incidence in aged patients. While nondisplaced fractures achieve good results by conservative treatment, surgical procedures are discussed controversially. Next to open reduction and internal fixation (ORIF), the primary use of reverse shoulder arthroplasty (RSA) has become increasingly important. The aim of this study was to investigate the clinical function, activities of daily living (ADL), as well as pain assessment in patients with PHFs, treated by ORIF or RSA. A retrospective comparison study was assessed. From November 2011 to March 2016, 34 patients (17 matched pairs) that had undergone either ORIF or RSA of the proximal humerus, were included in this study. Pain was measured by numeric rating scale (NRS). ADL were obtained by Katz-Index and SF-12. Moreover, shoulder function was assessed using the Oxford Shoulder Score (OSS). The maximum range of motion (ROM) was also recorded. From November 2011 to March 2016, 34 patients (17 matched pairs) that had undergone either ORIF (Figure or RSA of the proximal humerus) were included in this study. For statistical analyses, Student's t-test, Wilcoxon test, and Chi-Quadrat test were used. Statistical significance was indicated with p < 0.05. Totally 34 patients with an average age of 76.6 years were included. Surgical treatment was performed on average 5.2 days after diagnosis, differing significantly between the two groups (RSA/ORIF: 6.9/3.5 days) The operation time of RSA (97 min) was significantly longer than for ORIF (78 min). Pain assessment, as well as the Katz-Index and the SF-12, showed no significant differences. Moreover, clinical shoulder function showed no significant discrepancies between the two surgical techniques. Aged patients with PHFs treated with RSA display similar results regarding clinical function, ADL as well as pain perception compared with ORIF. However, revision surgery rate was lower in patients who underwent RSA. Thus, the surgical treatment of PHFs by RSA represents an excellent alternative, especially with regard to an aging patient population.

Prior Shoulder Arthroscopy is Associated with Inferior Clinical Outcomes Following Primary Reverse Shoulder Arthroplasty for Rotator Cuff Tear Arthropathy

Background Various patient-related and condition-related factors can influence the clinical benefits of reverse shoulder arthroplasty (RSA). With the emergence of new potential joint-preserving arthroscopic interventions, understanding the impact of shoulder arthroscopy prior to RSA is increasingly relevant. Therefore, the purpose of this study was to understand the impact of previous ipsilateral shoulder arthroscopy on outcomes and shoulder function following RSA for rotator cuff tear arthropathy. Methods Patients who underwent RSA for rotator cuff tear arthropathy from June 2016 to September 2020 by a single surgeon were retrospectively reviewed from a prospectively collected clinical database. Patients were separated into two groups: 1) patients who underwent RSA following prior ipsilateral shoulder arthroscopy (RSAPA) and 2) patients who underwent RSA without previous shoulder surgery (RSA). Patient-reported outcomes (PROs), including SST, ASES, UCLA score, SAS score, and active shoulder range of motion were measured preoperatively and at a minimum 2 years postoperative. Results A total of 103 patients (n=38 RSAPA and n=65 control RSA) were analyzed. The mean duration of follow-up for patients with prior ipsilateral shoulder arthroscopy was significantly shorter compared to the control patients (RSAPA=33 months and RSA=50 months, p &lt; 0.0001). All PROs improved postoperatively (p &lt; 0.001). Improvements in PROs for RSAPA were diminished relative to RSA control group patients, including SST (RSAPA=5.4 vs RSA=7.6, p = 0.005), ASES (RSAPA=40.8 vs RSA=54.7, p = 0.021), and UCLA (RSAPA=16 vs RSA=20.7, p = 0.009) scores. Improvements in forward flexion (RSAPA=69° vs RSA=95°, p = 0.0003) and abduction (RSAPA= 67° vs RSA=83°, p = 0.003) were decreased in the RSAPA group compared to the control group (RSA). One patient (1.5%) with prior shoulder arthroscopy required revision due to recurrent instability, whereas no patients in the control group required revision surgery (p=0.25). Conclusion Patients with rotator cuff tear arthropathy who underwent RSA following prior shoulder arthroscopy demonstrated significant improvements in function and patient-reported outcomes, but these outcomes are diminished compared to those patients with no history of surgery.

Obstetric Brachial Plexus Palsy and Functional Implications: Which Joint in the Upper Extremity Is More Closely Associated?

Background and Objectives: The objective of this study is to examine the correlation between the active range of motion (ROM) of the affected upper extremity and functional capacity in children with Obstetric Brachial Plexus Palsy (OBPP) who have undergone the modified Hoffer tendon transfer technique. Materials and Methods: The study cohort comprised 52 children with OBPP, aged 4-14 years, who had undergone a shoulder tendon transfer. The ROM was quantified using a goniometer, while functionality was evaluated through the administration of the Brachial Plexus Outcome Measure (BPOM). Results: The study identified significant correlations between the shoulder ROM and the Brachial Plexus Outcome Measure (BPOM). Specifically, shoulder flexion (p = 0.017; r = 0.351) was positively associated with shoulder functionality, while shoulder internal rotation (p = 0.001; r = 0.481) was linked to appearance scores. A significant negative relationship was observed between elbow extension (p < 0.001; r = -0.512) and elbow and forearm activities. Conclusions: The study highlights the necessity of assessing both joint range of motion and body perception for effective treatment and follow-up, to improve the functionality and quality of life for children with OBPP.

Variable Resistance Training Combined With Static Traction Computer Vision Applied in Neck and Shoulder Rehabilitation Training for College Students

This study evaluates the effectiveness of static traction combined with variable resistance training in rehabilitating college students with neck and shoulder diseases. Ninety students were randomly assigned to receive either static traction alone or combined therapy. Visual analogue scale (VAS), neck disability index (NDI), cervical range of motion, electromyography (EMG), and soft tissue parameters were assessed pre- and post-treatment. Both groups showed improved VAS and NDI scores post-treatment, with greater enhancements in the combined therapy group. Cervical range of motion, EMG values, and soft tissue parameters also favored the combined therapy. Statistical analysis revealed significant differences (P&amp;lt;0.05) between groups. Static traction combined with variable resistance training effectively improves neck and shoulder function, reduces pain, and enhances rehabilitation outcomes compared to static traction alone. This approach shows promise for optimizing rehabilitation in college students with similar musculoskeletal conditions.

Capsular Stretches and Shoulder Mobility Exercises to Improve Range of Motion of Secondary Adhesive Capsulitis Following Recurrent Shoulder Dislocation - A Case Report

The majority of patients will experience some post-traumatic stiffness following traumatic anterior shoulder dislocation, but this typically goes away on its own. Rarely do traumatic anterior shoulder instability result in secondary frozen shoulder. However, a tiny but expected percentage of patients who first have frozen shoulder may later experience secondary frozen shoulder, which causes pain and stiffness and slows rehabilitation. It's possible that this will happen after a period of shoulder immobilization, albeit the exact cause is still unknown. This case report details the results of professional physical therapy interventions used to treat secondary adhesive capsulitis after recurrent anterior shoulder dislocations using a conservative approach. This case study aimed to show how physical therapy can help people with secondary adhesive capsulitis restore, range of motion, strength and improve shoulder function.

Scapula position test reliability and comparisons of scapula position and shoulder function among individuals with and without adolescent idiopathic scoliosis.

An evaluation of scapula position is important to predict spine curvature and shoulder function in patients with adolescent idiopathic scoliosis (AIS). Therefore, a reliable scapula position is required to assess posture in patients with AIS. This study investigated the reliabilities of scapula position tests and differences in scapula position and shoulder function between individuals with and without AIS. The study compared 18 patients with AIS and 18 healthy controls to identify differences in scapula position and shoulder function. The acromion-table distance, lateral displacement of the scapula, acromion depression, winged scapula, upward rotation of the scapula, and anterior tilt of the scapula were measured. Scapula position test reliabilities were assessed using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum clinically important difference (MCID). Shoulder function was measured using the Shoulder Pain and Disability Index. The reliabilities of scapula position tests (ICC 0.85-0.93, SEM 0.1-1.2, and MCID 0.2-2.5) were good. There were significant differences in scapula position and shoulder function between patients with AIS and healthy controls (p< 0.05). Scapula position tests were highly reliable in patients with AIS; they can be used to evaluate scapula position during clinical assessment of posture in patients with AIS.

A prospective cohort study: promising results with minimally invasive plate osteosynthesis of anterior bridge plating in adult humeral shaft fractures.

Adult humeral shaft fractures have traditionally been managed conservatively, but surgical intervention is considered for displaced fractures or when conservative treatment is unlikely to be successful. The optimal surgical approach remains controversial, with open reduction and internal fixation (ORIF) using plates and screws considered the gold standard. However, concerns about soft tissue damage have led to the development of less invasive techniques, such as anterior bridge plating using minimally invasive plate osteosynthesis (MIPO). This study aimed to evaluate the outcomes of MIPO for humeral shaft fractures. A prospective cohort study included 43 patients who underwent anterior bridge plating with MIPO for closed, displaced humeral shaft fractures. Forty patients had full follow-up (functional and radiological) and three patients were lost to follow-up. Fractures were classified using the AO classification system. Surgical technique involved incision, reduction, and fixation with locking compression plates. Follow-up assessments were conducted at various intervals, and functional outcomes were evaluated. Fracture union was achieved in 38 of 40 patients (95%). Two patients required secondary bone grafts for non-union. The mean time to union was between 12 and 16 weeks. Excellent shoulder function was observed in 82.5% of patients, and excellent elbow function in 77.5%. The range of motion on the operated side differed statistically significantly from the non-operated side but was not clinically significant. MIPO with anterior bridge plating is a viable option for the surgical management of humeral shaft fractures. It offers good fracture healing rates and satisfactory functional outcomes and avoids extensive soft tissue dissection associated with ORIF. Level of evidence: II.