Improvement In Shoulder Abduction Research Articles

Effects of Eccentric Versus Concentric Strengthening in Patients With Subacromial Pain Syndrome: A Randomized Controlled Trial.

Subacromial pain syndrome (SPS) is the most common cause of shoulder pain. Therapeutic exercise is the first-line treatment for SPS; however, the ideal exercise type remains unclear. Here, we compared the effects of eccentric and concentric strengthening in patients with SPS. Adding isolated eccentric strengthening to a multimodal physiotherapy program (MPP) would lead to greater improvements in outcomes compared with either MPP alone or adding isolated concentric strengthening to the MPP. Randomized controlled trial. Level 2. A total of 45 patients were randomized to eccentric strengthening (ESG), concentric strengthening (CSG), and control (CG) groups; all groups received the MPP. The strengthening groups also performed group-specific strengthening. Shoulder pain, abduction and external rotation (ER) strength, joint position sense (JPS), the Constant-Murley Score (CMS), and the Disabilities of the Arm, Shoulder and Hand score were collected at baseline, after 12 weeks of treatment, and at week 24. For CMS, ESG exhibited a greater, but not clinically meaningful, improvement than CSG and CG (P < 0.05). Eccentric abduction strength increased in ESG compared with CG. From baseline to follow-up, abduction strength increased in ESG compared with CSG and CG. Eccentric abduction strength increased in CSG compared with CG. JPS at abduction improved in the ESG compared with CG. Other between-group comparisons were not significant (P > 0.05). In SPS, eccentric strengthening provided added benefits, improving shoulder abduction strength and JPS at abduction, and was superior to concentric strengthening for improving shoulder abduction strength. Neither strengthening approach had an additional effect on shoulder function, pain, ER strength, or rotational JPS. Clinicians could implement eccentric strengthening as a motor control retraining for strength and proprioception gain rather than for pain relief and reducing disability.

Effect of Mobilization with Movement on Pain, Disability, and Range of Motion in Patients with Shoulder Pain and Movement Impairment: A Systematic Review and Meta-Analysis

Background: Shoulder pain is a disabling musculoskeletal disorder worldwide. Thus, it is important to identify interventions able to improve pain and disability. Objective: To investigate the effects of mobilization with movement (MWM) on pain, disability, and range of motion in patients with shoulder pain and movement impairment. Methods: A systematic search of different databases was performed. The systematic review protocol has been registered in PROSPERO (CRD42023404128). A random-effects model for meta-analysis was used to determine the mean difference (MD), standardized mean differences (SMD), and 95% confidence interval for the outcome of interest. Results: Twenty-six studies were included. Of these, eighteen were included in the meta-analysis. MWM improved pain during movement with a moderate effect SMD of (−0.6; 95% confidence interval, −1.1 to −0.1, I2 = 0%; N = 66;) and shoulder abduction MD of (12.7°; 1.3 to 24.0; I2 = 73%; N = 90) compared to sham MWM in the short term (0–6 weeks). Combined MWM and conventional rehabilitation improved pain at rest, with a MD of (−1.2; −2.2 to −0.2; I2 = 61%; N = 100), and disability SMD of (−1.3; confidence interval −2.2 to −0.4; I2 = 87%; N = 185) compared to conventional rehabilitation alone in the short term. Combined MWM and conventional rehabilitation also resulted in improvement in shoulder abduction and external rotation. Compared to Maitland, MWM resulted in improvement in the shoulder abduction MD (20.4°; confidence interval 4.3 to 36.5; I2 = 89%; N = 130) in the short term. There is no information regarding long-term effects. Conclusion: Evidence suggests that MWM may reduce shoulder pain and restore shoulder range of motion and function. Our findings are promising, but the evidence is not strong enough to recommend it pragmatically.

Long-term outcomes of teres major transfer for irreparable posterosuperior rotator cuff tears in patients aged

Massive rotator cuff tears are defined as irreparable when tendon-to-bone or tendon-to-tendon continuity with the adducted arm cannot be restored and severe muscle fatty infiltration is present. Tendon transfer is a palliative procedure that improves shoulder function and relieves pain. We reviewed the records of patients aged <65 years, whose irreparable posterosuperior rotator cuff tears had been managed with teres major tendon transfer at our institution. Their 5- and 10-year clinical and radiographic follow-up records were examined to assess long-term outcomes. Patients' Constant Score, Disabilities of the Arm, Shoulder, and Hand score, and the visual analog scale for pain were calculated before the procedure and at 5 and 10 years. There were 24 consecutive patients aged <65 years (mean, 59; 12 men and 12 women) who had received no prior treatment except rehabilitation. All patients underwent teres major tendon transfer due to the failure of conservative treatment. The mean Constant Score was 26 preoperatively and 68 and 66 at 5 and 10 years, respectively (P=.0001 and P=.25). The mean Disabilities of the Arm, Shoulder, and Hand scores were 62.2 preoperatively and 7.8 and 9.3 at 5 and 10 years, respectively (P=.0009 and P=.1). The mean visual analog scale scores at rest were 6.1 preoperatively, and 0.3 and 0.5 at 5 and 10 years, respectively (P=.0003 and P=.1). Based on Hamada's classification, at 5 years, 3 patients showed grade 2 changes, and another had grade 3 changes; at 10 years, 7 patients showed grade 2 changes, and one showed grade 3 changes. Complications (8%) developed after the 10-year evaluation and included pain in 1 patient and secondary rupture of the transfer in another. Improving shoulder function and reducing pain in relatively young patients with irreparable posterosuperior cuff tears involves replacing the lost muscle with a muscle-tendon transfer. The chief aims of the procedure are to restore the balance with the subscapularis muscle, achieve joint stability, keep the humeral head in the glenoid cavity, and improve shoulder abduction and external rotation. Teres major tendon transfer can achieve these goals. Altogether, 22 of our 24 patients experienced improved daily activity function and pain relief that became stable after 5 years. Teres major transfers are useful surgical procedures, particularly in younger patients and in those with high functional demands, providing good and stable long-term results.

The effect of botulinum toxin application on latissimus dorsi and teres major muscles in patients with brachial plexus birth palsy: An electron microscopic and clinical study.

In brachial plexus birth palsy (BPBP), botulinum toxin may be utilized to prevent glenohumeral dysplasia and to maintain the stable growth of the glenohumeral joint. Repeated injections may cause muscular atrophy and their functional effects are uncertain. The aim of this study was to compare the microstructure and the function of the muscles that received two injections before transfer with the muscles that were not injected. BPBP patients that were operated between January 2013 and December 2015 were included in the study. Latissimus dorsi and teres major muscles were transferred to humerus in standard fashion. Patients were divided in two groups according to bo-tulinum toxin status. Group 1 was toxin negative whereas Group 2 was toxin positive. For each patient, mean latissimus dorsi myocyte thickness (LDMT) was measured with electron microscopy and pre-operative and post-operative active shoulder abduction, flexion, external and internal rotation, and Mallet scores were evaluated with goniometry. Fourteen patients (seven patients per group) were evaluated. Five patients were female whereas nine were male. Mean LDMT was not affected significantly (p>0.05). The operation improved shoulder abduction, flexion, and external rotation significantly (p<0.05), independent of the toxin status. The internal rotation decreased significantly only in Group 2 (p<0.05). The Mallet score increased in both groups, but it was not significant (p>0.05), independent of the toxin status. Botulinum toxin that was applied twice prevented glenohumeral dysplasia and it did not cause permanent latissimus dorsi muscle atropy and function loss in late period. It augmented upper extremity functions by alleviating internal rotation contracture.

Alternative Nerve Transfer for Shoulder Function: Thoracodorsal and Medial Triceps to Anterior Axillary Nerve

Introduction:We describe a reliable approach for double nerve transfer of the medial triceps branch and thoracodorsal nerve to the axillary nerve to increase axonal input. We present a review of outcomes for both end-to-end and reverse end-to-side nerve transfer.Methods:A retrospective review of patients who underwent nerve transfer for improvement of shoulder abduction at Harborview Medical Center and Northwestern Memorial Hospital between 2012 and 2021 was conducted. Patients were prospectively contacted to fill out a 30 item Disabilities of the Arm, Shoulder and Hand questionnaire, with an option to upload a video demonstrating active range of motion.Results:Twenty-one patients with 23 affected extremities were included in the final analysis. Fifteen patients completed the prospective arm of the study (71% response rate). Seventy-nine percent of patient limbs achieved a Medical Research Council Motor Scale (MRC-MS) of 4 or greater, and measured shoulder abduction active range of motion (AROM) was 139.2 degrees (range, 29–174 degrees) and 140.9 degrees (range, 60–180 degrees) (P = 0.95) for end-to-end and reverse end-to-side, respectively. Comparing end-to-end with reverse end-to-side neurorrhaphy, outcomes, including follow-up, mean postoperative MRC-MS, mean change in MRC-MS, Disabilities of the Arm, Shoulder and Hand, abduction AROM, and flexion AROM, were not statistically different.Conclusions:We showed improvements in shoulder abduction with the thoracodorsal nerve, in addition to the medial triceps branch, to increase axonal donation and power the axillary nerve without sacrificing the spinal accessory nerve. Furthermore, we demonstrated improvements with reverse end-to-side coaptation when intraoperative stimulation of the axillary nerve revealed residual function.

Need for including Hand Eye Coordination and Hand Function Training in the Management of Adhesive Capsulitis - A non-randomized control trial.

Objectives:The objective of the study was to identify the effect of Maitland mobilization with hand-eye coordination and hand function exercises in the prognosis of adhesive capsulitis.Methods:This non-randomized control trial was done with 40 patients with adhesive capsulitis referred to the OPD at UCA College of Physiotherapy, Chennai. The study was performed for 8 months duration from August 2018 to March 2019. After providing a sufficient explanation of the procedure, the patients were divided into Group-A and Group-B. Group-A were allocated to Maitland group (n=20) (MG) and Group-B, were assigned to the Maitland, Hand-eye coordination and Hand Function exercises group (n=20) (MHG), respectively. We measured Quality of life using SF36 to know whether these patients had poor QOL compared to normative. Each patient underwent testing before the experiment to evaluate the range of motion of the shoulder (Abduction and External rotation) measured using a 180º goniometer, Functional Disability assessed using SPADI index. Statistical analysis was applied using SPSS version 20.0. Before the study, data normality was tested. A parametric test was used to compare pre-and post-intervention data in each Group-And also compare the MG vs. MHG. An α < 0.05 is the level of significance in all analyses.Results:A total of 40 subjects accounted for the study results. Their quality of life was significantly lower from the normative values. Both groups were homogenous at baseline with no significant difference between the ROM and SPADI scores. Both groups showed a significant improvement in ER, abduction ROM and SPADI scores, however the between group posttest analysis revealed that the Group-B subjects progressed significantly better.Conclusions:The study concluded that the Maitland mobilization and hand-eye coordination and hand function exercises are an effective tool in improving shoulder abduction, external rotation and shoulder functions.

P-PN002. Isolated axillary nerve injury: A case report

Introduction . The axillary nerve is a terminal branch of the posterior cord of the brachial plexus and derives from the ventral rami of the fifth and sixth cranial nerves. Its injury is infrequently diagnosed and a rare occurence. It generally appears secondary to the trauma and characterized by severe shoulder pain at night with limitation of the shoulder movements followed by shoulder atrophy in the following weeks. Case Illustration: A 22-year-old male was admitted with decreased of consciousness, headache, neck stiffness, subconjunctival hemorrhage, and decreased left arm strength along with range of movement, especially left shoulder abduction and left arm pronator after a motorcycle accident. Vital signs were unremarkable. Head CT scan showed minimal subarachnoid hemorrhage (SAH) at anterior interhemisphere falx, and tripod fracture at left zygomatic bone. Hand, humeral and antebrachii X-ray showed no fracture nor dislocation. Electromyography (EMG) test showed no nerve conduction velocity of left axillary nerve injury. Patient underwent physiotherapy and given neuroprotectors. After 7 days, there was a significant improvement in shoulder abduction and left arm pronation. Patient was then discharged and scheduled for further physiotherapy. Discussion . Isolated lesions of the axillary nerve occur most commonly after a fracture or dislocation around the shoulder. Most recover spontaneously. In this case, patient had a speed recovery a week after the injury. Electrodiagnostic study shows a physiologic block of nerve conduction in the axillary nerve. At the end of the week, patient showed significant strength. This might be due to temporary interruption of conduction without loss of axonal continuity (neuropraxia). Conclusion . Isolated axillary nerve injury is often a low-grade injury which progresses to full recovery without intervention. Electrodiagnostic study might reveal no nerve conduction. However, recovery of nerve conduction deficit is full, and requires days to weeks.

The Effects of Virtual Reality on Upper Extremity in Patients with Obstetric Brachial Plexus Injury

AbstractThe present study aimed to examine the effects of playing Nintendo Wii games on upper extremity functions compared with conventional physiotherapy, in children with obstetric brachial plexus injury (OBPI). Twenty-two patients with brachial plexus injuries were enrolled. The patients were divided into two groups by simple randomization. The control group (conventional physiotherapy group [CTG]: n = 11) received conventional physiotherapy for 6 weeks (40 minutes per day, for 4 days per week). The study group, called Nintendo Wii group (NWG; n = 11), received conventional physiotherapy as well as tennis, baseball, and boxing games with Nintendo Wii on days when there was no physical therapy. The upper extremity range of motion (ROM) was evaluated using a digital goniometer, motor function was assessed using the Active Movement Scale (AMS), and shoulder functions were assessed with the Mallet Scoring System (MSS). Virtual reality treatment had a positive effect on shoulder flexion, forearm pronation, wrist flexion, ROM, and functionality (p &lt; 0.05). There was a significant improvement in shoulder abduction and shoulder external rotation in the CTG (p &lt; 0.05). There was no significant difference in the MSS values of either groups (p &gt; 0.05). As per the AMS, in the NWG, the shoulder internal rotation increased significantly (p &lt; 0.05). Nintendo Wii treatment used in addition to conventional physiotherapy may be effective in increasing upper extremity functions in children with OBPI.

Functional Evaluation of Levator Scapulae Tendon to Supraspinatus in Adult Brachial Plexus Injuries.

Introduction Brachial plexus injuries are severe life-altering injuries. The surgical method to restore shoulder abduction in adult upper brachial plexus injuries involves the usage of nerve grafts and nerve transfers targeting the suprascapular and/or the axillary nerve. When the primary nerve surgery has been unsuccessful or recovery has been incomplete or with a late presentation, muscle transfer procedures are needed to provide or improve shoulder abduction. Levator scapulae to supraspinatus is a transfer to improve shoulder abduction in posttraumatic brachial plexus injuries. Material and Methods The study included 13 patients with the age ranging from 17 to 47 years with a mean age of 30 years. All these patients had preop shoulder abduction of Medical Research Council (MRC) grade ≤3. All had a minimum of MRC grade 4 of active elbow flexion. Eleven patients had primary surgery. Only patients with a minimum of 1 year postoperative follow-up were included. All 13 patients underwent levator scapulae transfer only. Results All patients had a stable shoulder postoperatively. The average increase in active shoulder abduction was from 6.15°(median: 0°) preoperatively to 61.92°(median: 60°), with an average gain in shoulder abduction of 49.61°(median: 50°). Conclusions Transfer of levator scapulae tendon to the supraspinatus is an option to improve shoulder abduction in posttraumatic brachial plexus. In conditions where supraspinatus alone is not functioning, levator scapulae is the best available transfer, considering its strength and maintaining the form of the shoulder unlike trapezius transfer. In patients with previous surgery where supraspinatus has recovered partially but not functionally significant, this tendon transfer can be considered for the augmentation of the existing shoulder abduction.

Effectiveness of Hot Pack with Caudal Glide and Antero-Posterior Glide Mobilisation to Improve Shoulder Abduction Range in Adhesive Capsulitis

Introduction: Adhesive capsulitis is a self-limiting regional skeletal condition of uncertain aetiology characterised by a progressive loss of both active and passive mobility of the glenohumeral joint in the shoulder complex. It begins insidiously with shoulder pain and dysfunction in middle aged and elderly population. Adhesive capsulitis predominantly affects the older population, affecting both the sexes; however, female patients are affected more. Aim: To find the effect on pain, Range of Motion (ROM) and disability in subjects with adhesive capsulitis treated with hot pack along with caudal glide versus hot pack along with antero-posterior glide mobilisation. Materials and Methods: The study, quasi experimental, was conducted on 80 subjects which were further divided into two groups with 40 subjects in each groups. Subjects were evaluated for pain, ROM and disability index. Group A received antero-posterior glide mobilisation with the hot pack, where as Group B received caudal glide mobilisation with hot pack for thrice a week for three weeks completing a total of nine sessions. The statistical analysis was done using one-way ANOVA and post-hoc t-test for calculating within and between group differences. The parameters that were measured were Visual Analogue Scale (VAS), ROM, Shoulder Pain and Disability Index (SPADI). Results: The p-value after three weeks between the groups was 0.02, 0.0001, and 0.014 for VAS, ROM and disability. There was significant difference in the pre and post values in both Group A and Group B. Post-treatment values of VAS (p=0.0001), ROM (p=0.0001), and SPADI (p=0.0001) in Group B were showed more improvement than the post-treatment values of VAS, ROM and SPADI in Group A. Conclusion: Caudal glide mobilisation is more effective in improving pain, abduction ROM and SPADI index in patients with adhesive capsulitis.

Functional status in adhesive capsulitis - yoga vs. physiotherapy: a quasi experimental study.

Adhesive capsulitis results in a multidimensional disability which demands a polygonal approach. Although physiotherapy proves an essential for a complete and comprehensive recovery in adhesive capsulitis, evidence also suggest the role of yoga in the management, hence this study investigate their effectiveness. This is a quasi-randomised control study. A pre-diagnosed subacute and chronic adhesive capsulitis of shoulder, between the age group of 35-60 years of both genders of total 40 participants were randomly divided into Group 'A' (yogasana) and Group 'B' (physiotherapy). The parameters of pain, joint mobility and functional disabilities were measured at the baseline and after four-weeks. The mean age of Group 'A' was 45.4±7.78 years whereas 50.05±5.98 years was in Group 'B'. Intragroup analysis for both the groups showed statistically significant improvement in all the study variables. Whereas in intergroup analysis yogasana was found to be statistically significant in improving shoulder abduction mobility, p=0.03, effect size r=0.35 and also in shoulder flexion (p=0.15, r=0.23) and shoulder internal rotation (p=0.07, r=0.3), though statistically not significant, in view of small effect size response. Both techniques improved the functional status in adhesive capsulitis, however additional effects on joint mobility was demonstrated by yogasana.

Graft Tensioning in Superior Capsular Reconstruction Improves Glenohumeral Joint Kinematics in Massive Irreparable Rotator Cuff Tears: A Biomechanical Study of the Influence of Superior Capsular Reconstruction on Dynamic Shoulder Abduction.

Background:Superior capsular reconstruction (SCR) for massive, irreparable rotator cuff tears has become more widely used recently; however, ideal tensioning of the graft and the influence on joint kinematics remain unknown.Purpose/Hypothesis:The purpose of this study was to assess the effects of graft tensioning on glenohumeral joint kinematics after SCR using a dermal allograft. The hypothesis was that a graft fixed under tension would result in increased glenohumeral abduction motion and decreased cumulative deltoid forces compared with a nontensioned graft.Study Design:Controlled laboratory study.Methods:A total of 10 fresh-frozen cadaveric shoulders were tested using a dynamic shoulder simulator. Each shoulder underwent the following 4 conditions: (1) native, (2) simulated irreparable supraspinatus (SSP) tear, (3) SCR using a nontensioned acellular dermal allograft, and (4) SCR using a graft tensioned with 30 to 35 N. Mean values for maximum glenohumeral abduction and cumulative deltoid forces were recorded. The critical shoulder angle (CSA) was also assessed.Results:Native shoulders required a mean (±SE) deltoid force of 193.2 ± 45.1 N to achieve maximum glenohumeral abduction (79.8° ± 5.8°). Compared with native shoulders, abduction decreased after SSP tears by 32% (54.3° ± 13.7°; P = .04), whereas cumulative deltoid forces increased by 23% (252.1 ± 68.3 N; P = .04). The nontensioned SCR showed no significant difference in shoulder abduction (54.1° ± 16.1°) and required deltoid forces (277.8 ± 39.8 N) when compared with the SSP tear state. In contrast, a tensioned graft led to significantly improved shoulder abduction compared with the SSP tear state (P = .04) although abduction and deltoid forces could not be restored to the native state (P = .01). A positive correlation between CSA and maximum abduction was found for the tensioned-graft SCR state (r = 0.685; P = .02).Conclusion:SCR using a graft fixed under tension demonstrated a significant increase in maximum shoulder abduction compared with a nontensioned graft; however, abduction remained significantly less than the intact state. The nontensioned SCR showed no significant improvement in glenohumeral kinematics compared with the SSP tear state.Clinical Relevance:Because significant improvement in shoulder function after SCR may be expected only when the graft is adequately tensioned, accurate graft measurement and adequate tension of at least 30 N should be considered during the surgical procedure. SCR with a tensioned graft may help maintain sufficient acromiohumeral distance, improve clinical outcomes, and reduce postoperative complications.

A Novel Modification of Woodward Procedure for Correction of Sprengel Deformity by Application of Anchoring Sutures.

To report the functional and cosmetic results of cases with Sprengel deformity (SD) who underwent a novel technical modification in Woodward procedure for severe SD comprising of lowering of the scapula followed by stabilization of scapula with application of anchoring sutures. Twenty-three children were operated at a mean age of 6.6 ± 2.5years (range 3.4-11years) and followed up for a mean period of 5.51 ± 1.98years. The mean Cavendish score of the patients before procedure of 3.2 ± 0.45 was reduced to 1.7 ± 0.56 (p < 0.001) after the surgery. All patients improved in global shoulder abduction. The mean preoperative abduction of 97° ± 15.2° increased to a mean of 149° ± 14.1° post-operatively (p < 0.001). Significant improvement was also observed in mean Rigault grades after surgical intervention using anchoring suture modification of Woodward procedure. The mean Rigault grade of 2.7 ± 0.47 prior to surgery was reduced to 1.3 ± 0.47 (p < 0.001) at final evaluation. Age of the patients negatively correlated with the functional outcome (r = - 0.48; p < 0.02). The presence of an omovertebral bar or associated congenital anomalies did not affect the functional outcome. The modification of Woodward procedure for correction of SD by application of anchoring sutures was a reliable method for correction of SD particularly at younger age. The procedure was associated with significant improvement in shoulder abduction, cosmetic appearance and radiological grades over 5 year follow-up.

Trapezius Transfer to Restore Shoulder Function in Traumatic Brachial Plexus Injury: Revisited and Modified.

Background: Trapezius transfer has shown promise to restore shoulder movements and has stood through the passage of time. We here in describe a modification of trapezius transfer technique and review the current literature available. Methods: The modified trapezius transfer in which the trapezius muscle is extended with folded tensor fascia lata graft and attached as distally possible to the deltoid insertion was done in twelve patients at tertiary health care centre in India. Post-operative splinting and staged physiotherapy were given. Results: Results were described in the form of improvement in degree of shoulder abduction and Disabilities of the Arm, Shoulder and Hand (DASH) score. Six months post-surgery there were improvement in shoulder abduction and DASH score with mean 116 degrees (10-180 degree) and 38 (23-58) respectively. One patient showed poor results due to poor compliance in post-operative period. There were no major complications observed. Conclusions: The modified technique of trapezius transfer described here is a feasible option with good biomechanical outcomes. The technique is simple and can be adopted easily by emerging brachial plexus surgeon as a technique for secondary reconstruction of shoulder joint.

Teres major transfer to restore external rotation of shoulder in Erb palsy patients

The lack of external rotation and shoulder abduction as sequelae of obstetric brachial plexus palsy requires a release of the subscapularis muscle associated with tendon transfer of the internal rotator of the shoulder. The aim of this study was to present the results of a teres major transfer to the infraspinatus tendon. This study included 20 patients (9 boys and 11 girls) with a mean age of 3 years 8 months (range, 1.5-14 years). The average follow-up time was 42 months (range, 12-48 months) to determine whether external rotation weakness and internal rotation contracture sequelae were managed by anterior release of the subscapularis and teres major tendon transfer to the infraspinatus tendon. We found marked improvement in shoulder abduction from 67° before surgery to 158° after surgery. We also found marked improvements in active external rotation from 8° before surgery to 85° after surgery and in passive external rotation from 0° preoperatively to 72° postoperatively. Two cases showed a loss of the last degrees of internal rotation, but this improved after physiotherapy. Anterior release of the subscapularis tendon with a teres major transfer to the infraspinatus tendon significantly improves shoulder function in Erb palsy patients with internal rotation contracture.

Arthroscopic versus open release of internal rotation contracture in the obstetrical brachial plexus paralysis (OBPP) sequela

Latissimus dorsi (LD) and teres major (TM) tendon transfers are effective surgical procedures to improve shoulder abduction and external rotation for children with obstetrical brachial plexus palsy (OBPP). Open pectoralis major (PM) tendon Z-plasty and arthroscopic subscapularis (SS) release are 2 options for the release of internal rotation contractures to enhance muscle transfers. This study compared the functional results of LD and TM tendon transfers with open PM tendon Z-plasty or arthroscopic SS release. The study included 24 patients who underwent LD and TM tendon transfers for OBPP (9 arthroscopic SS release, 15 open PM tendon Z-plasty) with a mean follow-up of 41.33 months (range, 36-60 months) and 47.2 months (range, 36-60 months), respectively. Functional evaluation was made according to range of motion and Mallet scoring system. Shoulder abduction-external rotation degrees and scores in all sections of the Mallet scoring system significantly increased in both groups (P < .001). Postoperatively, the arthroscopic SS release group had significantly better abduction degrees (P = .003), total Mallet scores (P < .001), and superior abduction (P = .043), active external rotation (P = .043), hand-to-head (P = .043), and hand-to-mouth (P < .001) scores for the Mallet scoring system. Transfer of LD together with TM tendons combined with one of the internal rotation contracture release procedures yielded good clinical and functional results in patients younger than age 7, regardless of the type of release method. However, arthroscopic SS release, although requiring an experienced surgeon, revealed better clinical and functional outcomes and is considered to be a less invasive and superior method.

Comparative Effectiveness of Ultrasound-Guided Intratendinous Prolotherapy Injection with Conventional Treatment to Treat Focal Supraspinatus Tendinosis.

Objective To evaluate the efficacy of dextrose prolotherapy injection for focal supraspinatus rotator cuff tendinosis via outcomes such as functional score, range of movement, and real-time ultrasound parameters. Materials and Methods 12 adult patients with focal supraspinatus tendinosis recruited after they had less than 30% improvement in functional (DASH) scores after one month of physiotherapy following initial presentation. Seven patients had 0.5–1.0 ml of prolotherapy injection (12.5% dextrose, 0.5% lignocaine) injected into the area of focal tendinosis under ultrasound guidance. Meanwhile, five patients continued standard physiotherapy with no intervention performed. Regional area of echogenicity in decibels, DASH, range of movements of the shoulder, pain, and sleep scores were measured at baseline and at 12 weeks. Results The prolotherapy group showed significant improvement in shoulder abduction (p=0.030) and an improvement in sleep score (p=0.027). The echogenicity of area of tendinosis significantly increases at the end of treatment (p=0.009). However, there was a nonsignificant reduction in pain score in the injection group (43.5%) and in the control group (25%) at 12 weeks (p > 0.005). Conclusion Ultrasound-guided intratendinous prolotherapy injection significantly improves patient's range of abduction and improves sleep within 12 weeks of treatment compared to conventional physiotherapy management. Trial Registration This study was registered under Current Controlled Trials (UK) and given International Standard Randomised Controlled Trial Number (ISRCTN) of 43520960.

Sprengel's deformity correction by vertical scapular osteotomy ina paediatric age group: influence of rib cage abnormalities.

Vertical scapular osteotomy (VSO) is a known procedure for Sprengel's shoulder deformity. Its surgical results in the presence of rib cage anomalies largely remain unreported. The influence of simple and complex rib anomalies on shoulder abduction, Cavendish grade, and radiological Rigault's score following VSO was studied retrospectively in eight paediatric patients. The omovertebral bar effect on surgical outcome was also observed. The average age at surgery was 6.8years. Rib anomalies were found in seven patients among which four had simple (50%) and three complex rib anomalies (37.5%). At mean post-surgery follow-up of fouryears, the overall average gain in shoulder abduction was 21°. In patients having either no or simple rib anomalies (n = 5), the mean pre-operative abduction and follow-up increase was more (132°; gain 28°) compared to complex rib anomalies (110°; gain 10°). The overall average pre-operative Cavendish score changed from 2.8 to 1.5. The correction was more complete in simple or no rib anomalies. The mean preoperative Rigault score was 2.25 with only a small improvement (0.38) noted in follow-up. Two patients with omovertebral bar attained good cosmetic and functional results. The current study was at variance with the previously published studies in terms of improved shoulder abduction following VSO especially complex rib anomalies. The omovertebral bar was not an adverse prognosticating factor.

Lower Trapezius Transfer for Patients With Brachial Plexus Injury.

Brachial plexus injury is a complex entity that often results in partial recovery. Most studies to date have focused on improving shoulder abduction. However, a recent technique has been outlined-one that transfers the lower trapezius to improve the external rotation of the shoulder. The primary objective of this study was to evaluate the gains in external rotation of the shoulder in patients who have undergone transfer of the lower trapezius; secondarily, we assessed the range of motion in the elbow and shoulder joints, as well as the muscle strength and quality of life. This article presents a prospective cohort study of 10 patients who underwent transfer of the lower trapezius. During the preoperative period and at 6 months after the operation, both active and passive goniometric measurements were assessed, as were muscle strength, Mallet's classification, and patients' responses to the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. External rotation exhibited an improvement of 17° in the active range of motion and 14° the passive range, which was not statistically significant. Flexion and active abduction of the shoulder, as well as the responses to the DASH, showed positive results. The Mallet's classification and muscle strength measurement results were not significant. The procedure might be an alternative for restoration of shoulder function and glenohumeral stabilization and mainly to improve quality of life. However, additional studies are required to define and refine this surgical technique.

The effect of home-based program and outpatient physical therapy in patients with head and neck cancer: A randomized, controlled trial

ObjectivesPhysical therapy improves outcomes for patients with head and neck cancer (HNC) but home-based program (HBP) has not yet been investigated thoroughly. This study compared a HBP with outpatient physical therapy (OPT). MethodsThis trial categorized patients with primary HNC into OPT and HBP groups. The patients in the HBP group received home-based therapy once a day for 5 days per week. By contrast, the OPT group received various physical therapies, including aerobic, anaerobic, and stretching therapies, twice per week, plus a thrice-weekly home-based therapy that similarly consisted of aerobic, anaerobic, and stretching exercises. The major outcome was the Functional Assessment of Cancer Therapy—Head and Neck (FACT H&N), and secondary outcomes were the visual analog scale (VAS) of shoulder pain, 6-min walking test (6MWT), and shoulder range of motion (ROM), all of which were evaluated before, during, and after interventions. ResultsSignificant improvements were found after 12 weeks of the HBP or OPT. The HBP was not inferior to OPT regarding FACT H&N (p=.074), VAS of shoulder pain (p=.677), 6MWT (p = .677), and shoulder ROM (p=.145 for flexion; p=.383 for abduction). ConclusionsBoth the HBP and OPT can improve shoulder abduction, shoulder flexion and functional capacity.