Glenohumeral Research Articles

Biomechanical effects of deltoid muscle atrophy on rotator cuff tissue: a finite element study

The deltoid muscle and rotator cuff tissue are structural components that maintain the dynamic stability of the shoulder joint. However, atrophy of the deltoid muscle may affect the stability of the shoulder joint, which in turn alters the mechanical distribution of rotator cuff tissue. Currently, the effect of muscle volume changes in the deltoid muscle on reducing the load on the rotator cuff tissue is still unknown. Therefore, this paper intends to analyze the mechanical changes of rotator cuff tissue by deltoid muscle atrophy through finite elements. Based on previously published finite element shoulder models, the deltoid muscle was modeled by constructing deltoid muscle models with different degrees of atrophy as, 100% deltoid muscle (Group 1), 80% deltoid muscle (Group 2), and 50% deltoid muscle (Group 3), respectively. The three models were given the same external load to simulate glenohumeral joint abduction, and the stress changes in the rotator cuff tissue were analyzed and recorded. In all three models, the stress in the rotator cuff tissue showed different degrees of increase with the increase of abduction angle, especially in the supraspinatus muscle. At 90° of glenohumeral abduction, supraspinatus stress increased by 58% and 118% in Group 2 and Group 3, respectively, compared with Group 1; In the subscapularis, the stress in Group 3 increased by 59% and 25% compared with Group 1 and Group 2, respectively. In addition, the stress of the infraspinatus muscle and teres minor muscle in Group 2 and Group 3 were higher than that in Group 1 during the abduction angle from 30° to 90°. Deltoid atrophy alters the abduction movement pattern of the glenohumeral joint. During glenohumeral abduction activity, deltoid atrophy significantly increases the stress on the rotator cuff tissue, whereas normal deltoid volume helps maintain the mechanical balance of the rotator cuff tissue.

Imaging of glenohumeral osteoarthritis: Reliability and reproducibility of radiological classifications.

Glenohumeral degenerative joint disease may affect up to 20% of the population. There are several classification systems of this disease in the scientific literature. The aim of this study is to determine the reliability and reproducibility of glenohumeral osteoarthritis classification systems. We assessed glenohumeral plain radiographs performed in a University Hospital. These radiographs were graded into nine radiological classification systems by two observers on two evaluations. Patients who have performed CT/MRI scan were staged according to the Walch classification. The intra-observer and inter-observer reliability of the classification schemes were determined by using Cohen's weighted kappa coefficient. A total of 752patients were included in the study (52.4%females and 47.6%males), mean aged 66.2 ± 16.3years. The intra-observer and inter-observer reliabilities were 0.543 (observer 1), 0.630 (observer 2), and 0.760 (inter-observer) for the Weinstein grading system; 0.661, 0.706, and 0.761 for the Guyette grading system; 0.575, 0.679 and 0.704 for the Kellgren and Lawrence classification; 0.817, 0.816 e 0.871 for the Samilson and Prieto classification; 0.791, 0.811 and 0.847 for the Allain modification; 0.797, 0.842 and 0.860 for the Gerber modification; 0.773, 0.827 and 0.828 for the Buscayret modification; 0.584, 0.648 and 0.755 for the Hawkins and Angelo classification; 0.661, 0.749 and 0.764 for the Rosenberg classification. Intra-observer reliability for MRI was 0.757 (observer 1) and 0.675 (observer 2), while intra-observer reliability for CT was 0.811 (observer 1) and 0.653 (observer 2). Inter-observer reliabilities were 0.790 for MRI and 0.673 for CT. The classification systems according to Weinstein, Guyette, Hawkins and Angelo, Rosenberg and the modifications of the Samilson and Prieto classification according to Allain, Gerber and Buscayret showed a comparable reliability with the commonly used glenohumeral osteoarthritis grading systems, Samilson and Prieto and Kellgren and Lawrence. Thus, they are recommended for clinical and especially scientific purposes.

Wheelchair Basketball: morpho-functional and physiological aspects of the shoulder

Wheelchair basketball is one of the most popular paralympic sports. It is a great physical activity that guarantees important health benefits and promotes the well-being and social inclusion for disabled people. At the same time, wheelchair basketball involves a significant risk of injuries for wheelchair basketball players and upper limbs are the most burdened body segments. In particular, sport specific gestures lead to progressive overload of the shoulder joint, which usually results in shoulder pain. For these reasons, scientific and technological progress should improve the development of rehabilitative strategies to promote shoulder health and then to reduce shoulder pain. Within the spectrum of new technologies, electromyography is a tool that allows real-time measurement and to take advantage of the potentiality of biofeedback, so it has been used previously to improve the outcome of rehabilitation treatments. Therefore, the purpose of this review is to summarize and analyze the current evidence regarding the use of electromyography, as a rehabilitative strategy, to reduce shoulder pain in wheelchair basketball athletes. Following the PRISMA statement guidelines (PROSPERO - 2023, n° CRD42023470395), a total of 10 studies met the inclusion and exclusion criteria after a search of three databases (Pubmed, Google Scholar and Cochrane Library). The result of this review highlights the importance of electromyography and surface electromyography in the prevention and treatment of shoulder pain in wheelchair basketball athletes. Moreover, this examination emphasizes that using surface electromyography as a biofeedback seems to be an effective way to speed up shoulder pain rehabilitation outcomes in wheelchair basketball athletes. Keywords: exercise; sport; technologies; rehabilitation, physiology.

Magnetic resonance arthrography with positional manoeuvre for the diagnosis of synovial fold of posterior shoulder joint capsule.

The objective of this study is to prospectively assess the effectiveness of shoulder magnetic resonance (MR) arthrograms with positional manoeuvres in detecting posterior synovial folds. Two radiologists independently assessed all axial MR arthrograms in internal rotation, neutral position, and external rotation for the presence of a posterior synovial fold. The diagnostic performances of the MR arthrograms were then compared, with results validated through arthroscopy. Arthroscopy was performed on 81 of the 150 patients included in the study. A posterior synovial fold was identified arthroscopically in eleven of these patients. Measurements of the posterior synovial fold obtained in external rotation and the neutral position of the arm showed a significant correlation with arthroscopic results (p < 0.05). For detecting the posterior synovial fold with arthroscopic correlation, the sensitivity and specificity values for observer 1 and observer 2 were 100-81.4% and 100-88.6%, respectively, for MR arthrograms in the neutral position; 100-52.9% and 100-62.9% for MR arthrograms in external rotation; and 100-95.7% and 81.8-98.6% for MR arthrograms in internal rotation. There was a fair agreement for MR arthrography in external rotation for detecting posterior synovial folds, while MR arthrograms in internal rotation and neutral position showed near-perfect and significant interobserver agreement. The rotational positions of the humeral neck during MR arthrographic examination can influence the diagnostic specificity and sensitivity of axial MR arthrograms in detecting the posterior synovial fold. The posterior synovial fold can mimic a posterior labral detachment. Therefore, its correct identification is crucial in order to avoid unnecessary surgical procedures. Movement of the shoulder may introduce variability in MR arthrography appearance. Rotation of the humeral neck during MR arthrography can affect diagnoses in posterior synovial fold detection. Given that posterior synovial folds can imitate posterior labral detachment, their correct identification is crucial to avoid unnecessary surgical procedures.

Effect of electroacupuncture combined with rehabilitation techniques on shoulder function in patients with rotator cuff injuries.

The rotator cuff is located below the acromion and deltoid muscles and comprises multiple tendons that wrap around the humeral head, maintaining shoulder joint stability. To explore the effect of electroacupuncture combined with rehabilitation techniques on shoulder function in patients with rotator cuff injuries. We selected 97 patients with rotator cuff injuries treated in the People's Hospital of Yuhuan from February 2020 to May 2023. Patients were grouped using the envelope method. After treatment, the study group's treatment effective rate was 94.90% (46/49 patients), significantly higher than that in the control group (79.17%, 38/48 cases; P < 0.05). Before treatment, there was no difference in Constant Murley Score (CMS) scores, shoulder mobility, or 36-Item Short Form Health Survey (SF-36) scale scores (P > 0.05). Compared with those before treatment, the CMS scores (including pain, daily living ability, shoulder mobility, and muscle strength), all aspects of shoulder mobility (forward flexion, posterior extension, external rotation, internal rotation), and SF-36 scale scores (including physiological, psychological, emotional, physical, vitality, and health status) were higher in both groups after treatment and significantly higher in the study group (P < 0.05). There was no difference in the occurrence of complications between the two treatment groups (P > 0.05). Electroacupuncture combined with rehabilitation techniques has a good treatment effect on patients with rotator cuff injuries, helps accelerate the recovery of shoulder function, improves the quality of life, and is highly safe.

Changes in Shoulder Rotation Based on Elevation in Children With Brachial Plexus Birth Injury

Lack of shoulder external rotation is common in children with brachial plexus birth injuries. Development of glenohumeral (GH) dysplasia is associated with progressive loss of passive external rotation. Some authors recommend measuring external rotation with the arm adducted, whereas others recommend measurement with the arm in 90° of abduction. The purpose of this study was to compare active and passive external rotation and internal rotation measured in adduction versus abduction. Fifteen children with brachial plexus birth injuries held their affected arms in maximal external and internal rotation with the arm adducted and the arm at approximately 90° of abduction. Active and passive rotations were measured with three-dimensional motion capture. Scapulothoracic (ST) internal/external rotation and GH internal/external rotation joint angles were calculated and compared using multivariable, one-way repeated measures analyses of variance. There were no significant differences for active or passive ST rotation in external rotation in adduction versus abduction. Glenohumeral external rotation was significantly increased with the arm in abduction compared with adduction both actively and passively. There were no differences in ST rotation in active versus passive conditions, but all GH rotations were significantly greater passively. Shoulder internal/external rotation in abduction and adduction is not interchangeable. Comprehensive assessment of shoulder external and internal rotation should include both adduction and abduction. For children with brachial plexus birth injuries, both active and passive GH external rotations were greater in abduction. Therefore, early GH joint dysplasia may be missed if GH external rotation is measured in abduction. Additionally, consistency in arm position is important for comparison over time. The entire ST rotation capacity was used to perform maximal internal and external rotation, but the entire passive GH range of motion was not actively used. This highlights an area for potential surgical intervention to improve motion.

Comparison of the efficacy of phlebotomy under touch pain point and ultrasound-guided puncture decompression in the treatment of acute calcific supraspinatus tendinitis

To compare the efficacy of blood letting under pain point touch and ultrasound-guided puncture decompression in the treatment of acute supraspinatus muscle calcifying tendinitis. From January 2020 to January 2023, 45 patients with acute supraspinatus muscle calcifying tendinitis were selected and divided into treatment group and control group. In the treatment group, a total of 22 patients were treated with ultrasound-guided puncture decompression, including 16 females and 6 males, aged from 20 to 64 years old(39.31±5.80) years old, 11 on the left shoulder and 11 on the right shoulder. In the control group, there were 23 cases, including 15 females and 8 males, aged from 19 to 66 years old (40.67±6.13) years old, 12 on the left shoulder and 13 on the right shoulder. The treatment was treated with pain point touch bloodletting therapy. The visual analog scale (VAS) pain score, University of California, Los Angeles(UCLA) shoulder system score and shoulder Constant-Murley score were used to evaluate the therapeutic effect before treatment, 1 weeks, 1 month and 3 months after treatment, respectively. One patient in the control group gave up follow-up for personal reasons after 1 week of treatment, and the other 44 patients completed all follow-up. Six months after treatment, there were no recurrence cases in both groups. After statistical analysis, VAS pain score, UCLA score and Constant-Murley score of the treatment group and the control group were significantly different from those before treatment (P<0.05), and the improvement was more obvious in the treatment group. There was no statistical significance between the two groups (P>0.05). Bloodletting under pain point touch and ultrasound-guided puncture decompression are effective in the treatment of acute calcific supraspinatus tendinitis, with simple operation and low cost, which can effectively reduce local pain and effectively improve shoulder joint function. Primary hospitals can selectively operate treatment according to their own conditions.

Can acute mobilization and oscillation training profit on the joint position sense and strength of the rotator cuff muscles in young tennis players?

The rotator cuff is a group of muscles and tendons that act to stabilize the human shoulder and allow for its extensive range of motion. This study aimed to compare the immediate effect and durability of mobilization and oscillation dumbbell (OD) training on the Joint Position Sense (JPS) and strength of rotator cuff muscles in young tennis players. Twenty-six tennis players were divided into two experimental groups. G1 only performed mobilization techniques while G2 only performed OD training, before, after and after one week of the protocols, the strength and JPS of the shoulder joint were measured with an isokinetic dynamometer. Repeated analysis of variance (RMANOVA) and Bonferroni post hoc test were used to examine the differences between the groups. The analysis of covariance was used to examine the differences between the groups. In general, the results showed a significant effect of both mobilization techniques and OD training programs on the JPS and internal and external rotation strength of young tennis players, but only one difference was observed between the two in external rotation for the eccentric/concentric action at 120°/sec (p=0009; ƞ2p= 0.32). Moreover, the main findings showed that mobilization techniques and OD improved internal and external rotations after the protocol and after one week when compared with baseline for the concentric/concentric and eccentric/concentric at 60°/sec and 120°/sec (p &lt; 0.05) with only one exception for the internal rotation concentric/concentric at 120°/sec for both groups (p &gt; 0.05). Based on this, it seems that in healthy tennis players, both one-session mobilization techniques and OD training can be used to improve JPS and strength. Keywords: Shoulder, Isokinetic, Torque, Resistance, Rotator cuff.

Energy Flow during Baseball Machine Hitting.

The primary aims of the study were to perform a descriptive analysis of hitting energetics off a pitching machine and to compare between the rear- and lead-side lower and upper extremities. Eighty-five high school to minor league baseball athletes participated. Five full-effort swings off a pitching machine with the fastest exit velocity were used for analysis. Energy flow was quantified using a segment power analysis. Wilcoxon signed-rank test revealed significant differences between rear- and lead-side energetics during both swing phases. During the stride, the rear knee and shoulder generated more energy than the lead side. Throughout the swing phase the lead knee, hip, and elbow generated more energy than the rear side, but at the shoulder the rear side generated significantly more energy than the lead. Most intriguing, differing energy transfer directions between the rear and lead knee and shoulder joints were reported. Furthermore, descriptive results revealed energy is predominantly transferred across the knee, shoulder, and elbow joints, while the hips primarily display energy generation. The descriptive nature of the study provides a foundation for future research and can be used as a resource for training personnel to design effective training protocols aimed at maximizing performance.

EVALUATION OF CLINICAL RESULTS OF SURGICAL RESECTION OF SYNOVIAL OSTEOCHONDROMATOSIS IN THE SHOULDER: A RETROSPECTIVE STUDY

Synovial osteochondromatosis of the shoulder is a rare condition and its details remains unclear. Aim of this study was to evaluate the clinical results of surgical resection and histopathological characteristic of SOC of the shoulder. Ten shoulders with SOC were retrospectively assessed for demographic characteristic, history of trauma, presence of osteochondral loose bodies, inferior humeral osteophytes and acromial spurs. Visual analog scores for pain and functional scores using Constant scores were compared pre and post operatively. Resected lesions were histo-pathologically differentiated between primary and secondary SOC. The average age of patients was 39.8+/- 15.7 year; four female and six patients was male in our study. Average duration of symptoms was 11.5+/-8.11 months. Three shoulders has osteochondral lesion in subacromial space (30%) and seven in glenohumeral joint (70%). Five shoulders (71%) show inferior humeral osteophytes out of seven shoulders with lesion in glenohumeral joint. All three shoulder (100%) with SOC in the subacromial space had spur formation. One shoulder have primary SOC while other nine had secondary SOC. Average Visual analog scale pain score graded from 0 (no pain) to 100 mm( maximal pain) was 47.5+/-11.32 mm. The Constant score was improved from preoperative score 51.6+/-8.34 points to postoperative score 78.7+/-11.62. No case show recurrence of new loose bodies, acromial spur and inferior humeral osteophytes. Our study showed that resection of SOC successfully relieved the pain and clinical symptoms. Primary SOC is less common than secondary SOC and histopathological identification is needed to differentiate between both types. Thus further investigations required to determine long term prognosis SOC in the shoulder. KEYWORDS: osteochondromatosis, shoulder joint, synovium

Musculoskeletal system injuries in the Polish Territorial Defence Forces

BackgroundMusculoskeletal system injuries (MSIs) are the major health problem of soldiers. The aim of this study was to assess the types of MSIs that occurred most frequently among soldiers and...

Morphometric Analysis of Glenopolar Angle of the Scapula in Indian Population.

The glenopolar angle (GPA),usually ranges from 30° to 45°. GPA measures the tilt of the plane of the glenoid cavity in relation tothe axis of the body of the scapula passing from the superior pole of the glenoid cavity to the inferior angle of the scapula.It is essential to assess the results of surgeries for dislocated shoulders. Worse long-term outcomes can arise from glenoid misalignment in scapular neck fractures. When evaluating prognosis and planning therapy for shoulder injuries including scapular fractures, GPA assessment is essential. Still, there is a dearth of data on the normal range of GPA and its contributing elements, which calls for more study. The purpose of this study is to determine typical GPA values by utilizing radiographs and a sizable sample of scapular bone specimens. In this study, the GPA was assessed in 50 chest radiographs of anteroposterior (AP) view and Neer's view of individuals as well as 100 dried scapulae of any gender. The mean GPA obtained using the various methods was then statistically compared. All scapulae had an average GPA of 42.6°. Twenty-ninescapulae had GPA observations higher than 45°, with an average of 47.2°. Twenty-seven scapulae had GPA measurements below 40°, averaging 37.3°.Right-sided 62 scapulae with an average GPA of 43.1°were present. Thirty-eight of left-side scapulae had a GPA of 41.7° on average. It was determined that the 1.6° mean difference in GPA between the two groups was not statistically significant. The Kolmogorov-Smirnov test verified that the GPA data had a normal distribution. The homogeneity of variances across various measuring techniques was confirmed using Levene's test. The average GPA measured using the dry scapula approach was 42.6°, the average GPA measured using the AP view was 39.8°, and the average GPA measured using the Neer I view was 42.3°. The GPA means from these three approaches differed considerably (p=0.0014) according to a one-way Analysis of Variance (ANOVA). Fisher's least significant difference post hoc testing showed thatthe scapular bone specimens and the Neer I view revealed significantly higher GPA values than AP shoulder radiographs.The GPA values obtained from the osteological group and the Neer I perspective had a mean difference of 0.21°, which was practically identical and suggested that there was no statistically significant difference between these approaches. In order to diagnose and treat a variety of shoulder joint diseases, this study estimates the normal values of scapular GPA. Furthermore, it offers support for improved implant design in the context of Indian shoulder joint replacement and repair.Using every measurement technique, the GPA values on the right and left sides did not differ significantly.GPA results from various measuring methods varied significantly, which emphasizes the significance of methodological consistency in clinical and research settings.

A unique tribological inverted bearing solution for reverse shoulder arthroplasty: Vitamin E and ceramic (unique inverse pairings in rTSR)

Background Reverse total shoulder arthroplasty has gained popularity for various shoulder conditions and has evolved over time to accommodate for material changes and design philosophy including inverse materials. The tribological behaviour of shoulder arthroplasty has been extensively studied in relation to biological osteolysis which is a notable concern regarding component loosening. Methods This study aims to assess the wear performance of a vitamin E-stabilised glenosphere or conventional ultra-high-molecular-weight polyethylene glenosphere whilst paired with ceramic or cobalt–chrome–molybdenum inlay in a shoulder joint wear simulator. A cumulative total of five million cycles was utilised with gravimetric and visual analysis of wear. Results Gravimetric wear was observed to be the lowest when a vitamin E-stabilised glenosphere was paired with a ceramic inlay – demonstrating the greatest wear resistance. Conclusion Our results demonstrate that the combination of vitamin E-stabilised polyethylene glenosphere and ceramic inlay has improved wear resistance properties in load simulations when compared to other bearing surface combinations. This supports the use of the novel inverse combination in clinical practice to attain longer-term survivorship in reverse total shoulder replacements. Level of evidence Basic Science Study; Tribology

Short-Term Effects of Cold Therapy and Kinesio Taping on Pain Relief and Upper Extremity Functionality in Individuals with Rotator Cuff Tendonitis: A Randomized Study.

Background and Objectives: Rotator cuff tendonitis (RCT) is one of the most common shoulder pathologies. It causes pain, limits shoulder joint movements, and impairs function. Despite various treatment methods, there are currently no specific guidelines regarding the most effective intervention for RCT. To the best of our knowledge, no studies have compared the effects of Kinesio taping (KT) and cold therapy (CT) on individuals with RCT. To this end, this study aimed to investigate and compare the short-term effects of KT and CT on pain relief and upper extremity functionality in individuals with RCT. Materials and Methods: One hundred and fourteen individuals were assessed for eligibility. Fifty-two individuals with RCT who met the inclusion criteria and agreed to participate were randomly allocated into either the KT or the CT group. A standardized home exercise program was given to all the participants. Their pain intensity, upper extremity function, shoulder range of motion (ROM), and grip strength were evaluated initially and after the three days of KT or CT applications. Results: All the assessment values significantly improved in the KT group. In the CT group, only the pain scores (except for the numerical rating scale (NRS) pain score during activity) were significantly improved in the CT group at the end of the third day of application compared to the initial values (p < 0.05). For all the measurement outcomes, the effects of time × group interactions were statistically significant (p < 0.05) in favor of the KT group, except for the resting pain (p = 0.688). Conclusions: The findings suggest that KT and CT could be used as adjunctive modalities to exercise for resting and night pain relief in patients with RCT. KT also had positive effects on the activity pain, function, ROM, and grip strength. The use of KT along with an exercise program could be a more effective therapeutic choice than the use of CT for improving night pain, activity pain, and upper extremity function during the short-term rehabilitation of RCT patients.

Shoulder Motion Overestimated by Mallet Scores.

Brachial plexus birth injuries (BPBI) occur in up 0.4 to 4.6 per 1000 live births. Weakness about the shoulder and development of glenohumeral joint contractures are common sequalae of BPBI. Shoulder function in children with BPBI is frequently assessed using the modified Mallet classification to evaluate upper extremity motion deficits. The purpose of this study was to assess the accuracy of the abduction, external rotation, and hand-to-mouth Mallet classification scores in children with BPBI using motion capture. A retrospective study of 107 children with BPBI who underwent motion capture assessment and Mallet scores on the same date were reviewed. Motion capture measurements were used to calculate humerothoracic elevation and external rotation joint angles in the abduction/hand-to-mouth and external rotation positions, respectively. The humerothoracic joint angles were converted to the corresponding Mallet scores. Discrepancies between the Mallet scores determined by clinicians and those determined by motion capture were assessed. For abduction, 24.3% of Mallet scores were misclassified during clinical examination. Of the misclassified scores, 22 were overestimated by 1 point and 4 were underestimated by 1 point compared with motion capture. For external rotation, 72.9% of Mallet scores were misclassified during clinical examination. Only 5 patients had an HT elevation that was less than 40 degrees, with 4 of them (80%) having a Mallet hand-to-mouth score of 4. There were no differences in proportion of patients with HT elevation less than 40 degrees who had a Mallet score of 4 or a Mallet score less than 4. There was better agreement in global abduction Mallet scores compared with external rotation and hand-to-mouth Mallet scores. This difference was likely due to the complex compensatory strategies that patients employ while performing external rotation and hand-to-mouth positions. The inaccuracy of the clinically determined Mallet scores is alarming given that they are frequently utilized to assist with surgical indications and are commonly used as outcome measures. Level IV Case series.

MicroRNA-26a deficiency attenuates the severity of frozen shoulder in a mouse immobilization model.

The main pathogenesis of the frozen shoulder is thought to be the inflammation of the intra-articular synovium and subsequent fibrosis of the shoulder joint capsule. However, the molecular pathogenesis of the frozen shoulder is still unknown. A class of noncoding RNAs, microRNAs contribute to various diseases including musculoskeletal diseases. MicroRNA-26a (miR-26a) has been reported to be associated with fibrosis in several organs. This study aims to reveal the role of miR-26a on fibrosis in the shoulder capsule using a frozen shoulder model in miR-26a deficient (miR-26a KO) mice. MiR-26a KO and wild-type (WT) mice were investigated using a frozen shoulder model. The range of motion (ROM) of the shoulder, histopathological changes such as synovitis, and fibrosis-related gene expression in the model mice were evaluated to determine the role of miR-26a. In WT mice, both inflammatory cell infiltration and thickening of the inferior shoulder joint capsule were observed after 1 week of immobilization, and this thickening further progressed over the subsequent 6 weeks. However, the immobilized shoulder in miR-26a KO mice consistently exhibited significantly better ROM compared with WT mice at 1 and 6 weeks, and histological changes were significantly less severe. The expression of inflammation- and fibrosis-related genes was decreased in the miR-26a KO mice compared with WT mice at 1 and 6 weeks. Together, miR-26a deficiency attenuated the severity of frozen shoulder in the immobilization model mouse. The present study suggests that miR-26a has the potential to be a target miRNA for therapeutic approach to frozen shoulder.

Analysis of experience in the clinical use of dual-energy computed tomography in patients with undifferentiated arthritis

Dual-energy computed tomography (DECT) is a radiation diagnostic method that is used in rheumatology to verify microcrystalline arthritis, but in Russia this method is little known and the experience of its use is rather scarce.Objective of the research. To analyze the experience of using DECT in patients with undifferentiated arthritis and lesions of the axial skeleton in clinical practice.Material and Methods. The retrospective study included 20 patients (14 men and 6 women) observed at the V. A. Nasonova Research Institute of Rheumatology, who underwent DECT for diagnostic purposes. 13 patients with undifferentiated arthritis underwent DECT of peripheral joints to diagnose gout; 7 patients with an established diagnosis of gout (based on the 2015 ACR/EULAR classification criteria for gout) – to clarify the genesis of lesions to the axial joints and spine. The study was performed on a Siemens SOMATOM Definition Flash computed tomograph.Results. Using DECT in patients with undifferentiated arthritis, deposits of monosodium urate crystals (MSUc) were detected in 7 out of 13 (54 %), which made it possible to verify the diagnosis of gout. In the second sample, 6 out of 7 patients (85 %) showed signs of MSUc deposition on DECT, which explained the genesis of the existing complaints. Among these 6 patients, in 1 person, DECT revealed the presence of MSUc and calcium pyrophosphate crystals in the shoulder joint, which made it possible to make two diagnoses at once – gout and calcium pyrophosphate deposition disease.Conclusion. DECT in patients with undifferentiated arthritis makes it possible to verify the diagnosis of gout in more than half of the cases (54 %). In 85 % of patients with gout and pain in the back and axial joints of unknown origin, urate deposits are detected according to DECT. This method may be a useful tool for identifying microcrystalline arthritis of the axial joints, but further research is needed to implement the method in routine practice.

Management of Periarthritis Shoulder by Intra-Articular Steroid Injection and Shoulder Joint Manipulation

Management of Periarthritis Shoulder by Intra-Articular Steroid Injection and Shoulder Joint Manipulation

Dynamic ultrasound assessment of rotator cuff tears: The finger compression technique

AbstractThe article aims to introduce the finger compression technique as a novel dynamic compression technique that can be easily incorporated into the routine sonographic examination to enhance its diagnostic performance in the investigation of rotator cuff tears. The application of the finger compression technique is demonstrated with illustrations, ultrasound images, and videos. The finger compression technique can be applied in challenging ultrasound shoulder scans. The technique enables visualisation of movement of hyperechoic debris or hypertrophic synovial tissue filling the defect of the rotator cuff tear during real‐time dynamic scanning. It also helps to milk bursal fluid into the tendon gap and across the torn tendon into the shoulder joint. The real‐time finger compression technique is a fast, easy and useful supplementary technique for confirming the diagnosis of rotator cuff tears in the presence of severe tendinopathy complicated by bursal thickening and may help to more accurately characterise rotator cuff tears when present.

Mid-Term Functional Outcomes Of Arthroscopic Rotator Cuff Repair In Patients With Or Without Frozen Shoulder: A Single-Center Retrospective Cohort Study

Rotator cuff tear (RCT) accompanied by frozen shoulder is a challenge for orthopedic surgeons as RCTs are often treated with surgical repair which need protection of repair, whereas the treatment for frozen shoulder is physical therapy to restore the range of motion of the shoulder joint. There is no consensus for the ideal treatment if those pathologies occur at the same time. The primary aim of the study is to compare the mid-term functional surgical outcomes of RCT repair in patients with or without frozen shoulder. Patients who underwent arthroscopic repair for full-thickness RCT in our institution between January 2021 and January 2023 were retrospectively reviewed. Patients were divided into two groups: with or without frozen shoulder at the time of arthroscopic repair. Patients with frozen shoulder underwent manipulation under general anesthesia and their rotator interval was released with a radiofrequency prior to RCT repair. Patients’ visual analog pain score (VAS), Constant score, ASES score, and University of California Los Angeles (UCLA) scores were compared at their latest follow-up. A total of 39 patients (19 frozen and 20 non-frozen shoulders) with a mean 23.9 ± 2.7 months of follow-up were included in the study. At the latest follow-up, there was no statistical difference in frozen and non-frozen groups in the mean VAS, ASES, UCLA, and Constant scores. The findings of the present study suggest that preoperative frozen shoulder does not have a negative impact on arthroscopic RCT repair, if frozen shoulder pathology is addressed during surgery.