Left Shoulder Joint Research Articles

Management of Avabahuka Through Mashadi Navana Nasya along with Bahya Snehana and Swedana w.s.r to Frozen Shoulder

One of the Vatavyadhi induced by vitiated Vata and Kaphanubandha vata is Avabahuka. The symptoms of Avabahuka are similar to those of frozen shoulder, which is brought on by a rotator cuff lesion from the extracapsular cuff, such as partial tears in the supraspinatus tendon. Materials and Procedures: Shodhana Nasya has been recommended for a 49-year-old patient who has complained of discomfort and stiffness in the left shoulder joint and left lateral cervical region, as well as limited movement in these areas. Result: The patient's symptoms considerably subsided, including decreased neck and left shoulder joint discomfort and stiffness. Discussion: The patient received internal medicine along with Rukshana, Mukhabhyanga, Sarvang Abhyanga, sthanika Patra Pottali Swedana, Sarvanga Swedana, Mashadi Navana Nasya, and Upanaha, which helped to successfully treat the ailment.

Shoulder Joint Range of Motion Related to Dementia

Introduction: Dementia is caused by various diseases, including Alzheimer’s disease dementia (ADD) and dementia with Lewy bodies (DLB). We often encounter patients with dementia who have limited shoulder joint range of motion (ROM), especially those with behavioral and psychological symptoms of dementia (BPSD). But the relationship between the diseases of dementia and restricted shoulder joint ROM is currently unclear. Methods: We examined cognitive function and shoulder joint ROM in 234 new outpatients at 7 memory clinics in Japan. We assessed cognitive function using the Mini-Mental State Examination (MMSE) and Revised Hasegawa Dementia Scale (HDS-R) and BPSD using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Patients were categorized by dementia diagnosis (ADD, DLB, other dementia, and control). Right, left, and total shoulder joint ROM was assessed using validated the Japanese Orthopaedic Association (JOA) score. Results: We found significant associations of lower right, left, and total shoulder joint ROM scores with male sex, advanced age, higher NPI-Q score, lower HDS-R, and MMSE scores. Little difference was found between right and left shoulder joint ROM scores. Restricted shoulder joint ROM was related to serial 7, verbal frequency domain scores on the HDS-R and repeat score on the MMSE. It was also related to the hallucinations, irritability/lability and nighttime disturbances scores on the NPI-Q. Furthermore, the dementia groups, especially the DLB group, showed worse shoulder joint ROM than the control group. Conclusions: Dementia was significantly related to restricted shoulder joint ROM. Maintaining communication and social interaction may help maintain shoulder joint ROM.

ANALYSIS OF THE SPATIO-TEMPORAL CHARACTERISTICS OF THE TECHNIQUE OF KICKING WITH THE LEFT FOOT TO THE SIDE FROM THE LEFT-HANDED STANCE OF HIGHLY SKILLED ATHLETES SPECIALISING IN HAND-TO-HAND COMBAT

The relevance of the research topic. A wide arsenal of technical actions and a wide range of potential conflict situations that regularly occur in the course of martial arts determine the peculiarities of operations, actions and mechanisms for their improvement. The aim of the research was to analyse the indicators of the spatial-temporal structure of the technique of a kick with the left foot to the side from the left- handed stand performed by highly skilled sportsmen. Research methods: analysis of literature sources, video recording and biomechanical video computer analysis using the optoelectronic system "Qualisys", methods of mathematical statistics. Results. The movement of the biolinks of the athletes' body during the phase of preparing for the impact is from 0.03 m to 0.25 m. During the kicking phase, the values of the average velocities of the right ankle and right knee joints are 4.23 m·s-1 and 2.26 m·s -1 respectively. Conclusions. The execution of a blow is effective from the point of view of biomechanical analysis, and the indicators of the kinematic structure of movements during the execution of this blow can be used both as a reference sample of sports technique and for the development of model characteristics of movements based on them. The values of the average velocities of the shoulder, elbow, and carpal joints of the right hand during the walking phase are 0.50 m·s-1, 1.10 m·s-1, and 0.95 m·s-1, respectively. The average speed of the shoulder joint of the left hand is 0.69 m·s-1, the left elbow joint - 0.97 m·s-1, and the left carpal joint - 2.03 m·s-1. Such high indicators of the average speeds of the hand joints during the walking phase indicate swinging movements to increase the force of the impact due to the use of inertial forces. The movement of the biolinks of the athletes' body during the walking phase ranges from 0.08 m to 0.63 m. The values of the indicators of the joints of the upper limbs during the two support phases when performing a left leg kick to the side from the left stance are: right shoulder joint - 0.65 m·s-1, left shoulder joint -0.52 m·s-1, right elbow joint – 2.73 m·s-1, left elbow joint – 1.71 m·s-1, right and left carpal joints – 1.84 m·s-1. In the two-support phase, the movement of the studied body points of the athletes is in the range from 0.08 m to 0.56 m. The values of the average velocities of the studied body points of the athletes during the contact phase when performing a left leg kick to the side from the left stance range from 0.23 m s- 1 to 2.53 m·s-1, and the displacement of the same points during this phase is from 0.02 m to 0.20 m

The rat as a novel model for chronic rotator cuff injuries

Chronic rotator cuff injuries (CRCIs) still present a great challenge for orthopaedics surgeons. Many new therapeutic strategies are developed to facilitate repair and improve the healing process. However, there is no reliable animal model for chronic rotator cuff injury research. To present a new valuable rat model for future chronic rotator cuff injuries (CRCIs) repair studies, and describe the changes of CRCIs on the perspectives of histology, behavior and MRI. Sixty male Wistar rats were enrolled and underwent surgery of the left shoulder joint for persistent subacromial impingement. They were randomly divided into experimental group (n = 30, a 3D printed PEEK implant shuttled into the lower surface of the acromion) and sham operation group (n = 30, insert the same implant, but remove it immediately). Analyses of histology, behavior, MRI and inflammatory pain-related genes expression profiles were performed to evaluate the changes of CRCIs. After 2-weeks running, the rats in the experimental group exhibited compensatory gait patterns to protect the injured forelimb from loading after 2-weeks running. After 8-weeks running, the rats in the experimental group showed obvious CRCIs pathological changes: (1) acromion bone hyperplasia and thickening of the cortical bone; (2) supraspinatus muscle tendon of the humeral head: the bursal-side tendon was torn and layered with disordered structure, forming obvious gaps; the humeral-side tendon is partially broken, and has a neatly arranged collagen. Partial fat infiltration is found. The coronal T2-weighted images showed that abnormal tendon-to-bone junctions of the supraspinatus tendon. The signal intensity and continuity were destroyed with contracted tendon. At the nighttime, compared with the sham operation group, the expression level of IL-1β and COX-2 increased significantly (P = 0063, 0.0005) in the experimental group. The expression of COX-2 in experimental group is up-regulated about 1.5 times than that of daytime (P = 0.0011), but the expression of IL-1β, TNF-a, and NGF are all down-regulated (P = 0.0146, 0.0232, 0.0161). This novel rat model of chronic rotator cuff injuries has the similar characteristics with that of human shoulders. And it supplies a cost-effective, reliable animal model for advanced tissue engineered strategies and future therapeutic strategies.

USING 3D PRINTING FOR OPEN REDUCTION OF CHRONIC POSTERIOR SHOULDER DISLOCATION (CASE FROM PRACTICE)

Objective. An example of the treatment of a patient with chronic posterior dislocation of the shoulder, previously operated on by the Latarge technique due to recurrence of anterior instability, is given. Methods. The patient presented with an old fixed posterior dislocation of the left shoulder joint, large bone defect of the front part of the head (reverse Hill-Sachs). The patient has already undergone 2 operations on the left shoulder due to chronic anterior dislocation of the humeral head: 2018 — arthroscopy and capsuloplasty according to Bankart; 2020 — arthrotomy with Latarje transposition (due to recurrence of anterior instability). The peculiarity of this case is a bone block with screws located on the front surface of the glenoid made a massive defect front part of the humeral head. Planning performed on the basis of a CT scan of the shoulder joint in the FreeformPlus program. Assessment of functioning performed on the QuickDASH and Constant scales. The results. To improve the performance of intraoperative osteoplasty of the defect, a plastic model of the humeral head was printed for simulating bone graft and osteosynthesis. According to the QuickDASH scale before the operation, the patient had 45 points, that is, a significant decrease in the function of the upper limb — constant discomfort, pain. After surgery for 2 days — 35 points, 6 weeks — 12, and 3 months. — 12 points, that is, the patientʼs quality of life has improved significantly. According to the Constant scale before the operation, there were 16 points, of which: pain — 6, household activity — 2, range of motion — 8. After surgery on the 2nd day, a total of 33 points: pain — 10, household activity — 7, range of motion (passive) — 16, after 6 weeks — 80 points, this result remained after 3 months. Conclusion. The use of three-dimensional planning and an individual tool greatly facilitated the main stages ofsurgical intervention in the case of chronic posterior dislocation of the humeral head and made it possible to quickly and conveniently prepare a bone graft and install it in the defect. The printed navigation made it possible to perform a stabilizing osteosynthesis, ensure high patient satisfaction and a good functional result.

Особливості кутових характеристик техніки прямого удару правою рукою з лівосторонньої стійки у висококваліфікованих спортсменів, які спеціалізуються в рукопашному бою

Topicality. Among the most urgent and fundamental areas of hand-to-hand combat technique research, one can single out kinematic analysis within certain phases, as well as within the framework of a complete exercise. The Research Purpose is to determine of the angular characteristics of the right-hand strike technique from the left-sided stance of highly qualified athletes specializing in hand-to-hand combat. 12 highly qualified athletes took part in the research. The following Research Methods as theoretical analysis, pedagogical and mathematical methods have been used in the study. The Research Results. Since there is no swing phase of straight kick, the preparation phase of kicking immediately precedes the impact action phase. During the preparation phase, athletes slightly bend their left leg, the left knee joint angle decreases by 3,8° (from 123,1° to 119,3°), and in the left hip joint by 4,2° (from 134,4° to 130,2°). Since there is no early swing phase of straight kick, the preparation kick phase immediately precedes the percussive impact phase. During the preparation phase, athletes slightly bend their left leg, the left knee joint angle decreases by 3,8° (from 123,1° to 119,3°), and in the left hip joint angle – by 4,2° (from 134,4° to 130,2°). The right leg remains practically immobile: the right knee joint angle at the beginning of the phase is 137,1°, and at the end of the phase it is 136,5°, that is, it decreases by only 0,6°; the right hip joint angle at the beginning of the phase is 145,9°, and at the end of the phase is 147,8°, increasing by 1,9°. The angular indicators of the upper limbs movements during the preparation phase for the impact have the following changes: the left shoulder joint angle increases by 6° (from 44.6° to 50,6°), the left elbow joint angle decreases by 6° (from 57,3° to 51,3°), the right shoulder joint angle increases by 4,5° (from 30,4° to 34,9°), and in the right elbow joint angle increases by 19,8° (from 51,8° to 71,6°). Findings. The straight right hand kick from the left stance is one of the most widely used and effective kicks in hand-to-hand combat. Also, due this kick, the greatest damage is inflicted on the opponent.

Admitting a patient with musculoskeletal pain following COVID-19 disease

A significant proportion of patients who have had COVID-19 continue to suffer from persistent symptoms such as severe weakness, shortness of breath, joint pain, mood swings and memory impairment during the recovery phase. More than half of the patients experienced joint pain for the first time after recovery from COVID-19. Three months after COVID-19 episode, joint pain continued to occur in more than a third of patients. We observed a 47-year-old patient with moderate shoulder pain that occurred for the first time after COVID-19. The examination also revealed changes in the hip joint. The diagnosis was made: post-COVID syndrome with reactive arthritis of the left shoulder joint, deforming osteoarthritis of the left hip joint stage I, degenerative-dystrophic changes in the lumbosacral spine, lower back pain. The therapy was prescribed – Chondroguard® intramuscularly every other day according to the following scheme: the first three injections (day 1, 3, and 5) 1 ml (100 mg), then, from the fourth injection (day 7) – 2 ml (200 mg) every other day, a course of 30 injections. Positive dynamics were achieved. No adverse events were noted during the treatment. The patient continued taking the nutraceutical Chondroguard® TRIO orally for 2 months. During the observational period, no adverse events were noted. Thus, in cases where post COVID-19 musculoskeletal pain is caused by joint involvement, chondroprotective therapy is effective: stage 1 – injections, stage 2 – oral therapy.

Significance of Vedhan Karma in Restricted and Painful Shoulder Joint Diagnosed as Vatarakta

Vatarakta is a disease of Avarana pathology caused by vitiated Rakta and Vata. The Vata gets vitiated by its own causes and its movement gets restricted by vitiated Rakta which leads to Vatarakta. In this disease, Vata and Rakta get vitiated by distinct etiological factors. One of the major causes of Rakta and Vata Dushti is trauma as told by Acharya Charaka in Jwar chikitsa. Severe pain is the major symptom of Vatarakta that gets relieved instantly by Raktmokshan as advised by Acharya Charak. Vedhan Karma was selected for Raktamokshan.
 Vedhan Karma (piercing) is one of the eight surgical procedures (Ashtavidha Shashtra Karma) explained by Acharya Sushruta. It is very simple and cost-effective. The points of Vedhan are specific according to diseases.
 After proper history taking and diagnosis, if Vedhankarma is done in the appropriate place we get instant results. It is safe, time-saving, and cost-effective. Hence a study was carried out using Vedhankarma in a case of painful, restricted movements of the left shoulder joint which was diagnosed as Vatarakta. For Vedhan, Suchee Shastra (26 no. needle) was used. The patient got instant relief from pain and improvement in restricted movement.

Ayurvedic Approach in Management of Avabahuka (Adhesive Capsulitis)

Avabahuka is a condition where the Vata near the base of the shoulder constricts the Siras, preventing the shoulder joint from moving. The signs of adhesive capsulitis, also referred to as frozen shoulder or Avabahuka, may co-occur. The clinical illness known as frozen shoulder causes painful restrictions to both passive and active shoulder movements. A 25-year-old male patient arrived at the OPD with the main complaints of left shoulder joint pain, stiffness, restricted movement, and loss of sleep brought on by pain in the previous 12 months. The clinical presentation of the symptoms significantly improved when the patient underwent Panchakarma therapy, which includes Jambira-Pinda Sweda, Nrap Vallabha Taila Nasya, and the use of specific Ayurvedic medications.

Аналіз швидкісних характеристик техніки удару знизу в голову правою рукою з фронтальної стійки у висококваліфікованих спортсменів, які спеціалізуються в рукопашному бою

Topicality. Taking into account the physical conditions for the implementation of the necessary motor task, which directly affect and impose requirements on the level of technical, physical, and theoretical preparation of the performer, in order to achieve the desired final result of the athlete’s mechanical actions, a deep understanding of the importance of the relationship between the chosen technical method of performing a sports exercise and the biomechanical parameters of the performer’s movement is required as factors of the effectiveness of the implementation of this method of action. Objective of the Study is analysis of the speed characteristics of a blow from below to the head with the right hand from the front stance in highly qualified athletes who specialize in hand-to-hand combat. 12 highly qualified athletes took part in the research. Among them were 7 masters of sports of Ukraine and 5 masters of sports of international class. The following Research Methods were used in the study: theoretical, pedagogical, mathematical. Results of the Research. We analyzed the average speed indicators in different phases of a blow from below to the head with the right hand from the frontal stance in highly qualified athletes. Indicators of average velocities of various points of the body in the phase of preparation for impact, the highest velocities are the left carpal joint 0,93 m•s-1, the left elbow 0,69 m•s-1 and the left shoulder joints 0,65 m•s-1 respectively. The average velocities of the points of the right leg: ankle, knee and hip joints are 0,6 m•s-1, 0,96 m•s-1 and 1,12 m•s-1, respectively. Analogous indicators of the average velocities of the points of the left leg are 0,06 m•s-1, 0,55 m•s-1 and 0,64 m•s-1, respectively. Conclusions. The outlined problem for a wide range of scientific knowledge on sports training is not new, however, it is especially relevant for hand-to-hand combat due to the specifics of the implementation of motor actions.

A case study of the association between adolescent idiopathic scoliosis, weight training and shoulder dislocation

This study shows a rare association between the anomalous position of the shoulder girdle, due to scoliosis, with altered shoulder kinematics, injury of joint capsule ligaments and rotator cuff tendons, and shoulder dislocation due to a traumatic event. The subject has developed adolescent idiopathic scoliosis, with convex curvatures to the right side in the lower region of the thorax (with the Cobb angle of 13 degrees) and to the left side of the upper region of the thorax (with the Cobb angle of 24-degrees), both of them with the axial rotation of vertebra and with visible gibbosities. The upper axial rotation has a 6.5-degree, which causes an unbalance between the two shoulder girdles. In normal situations, the shoulder joint is turned 30 degrees anterior to the coronal plane, but in his case, the right shoulder girdle is pulled 28 degrees anterior by the groove, and the left one is pushed 34.5 degrees anterior by the gibbosity. The major effect of shoulder girdle unbalance appears to be the maximum extension of the upper limbs when the hands can’t be aligned to the coronal plane and this is an important risk factor for the injuries of the left shoulder joint, while some weight training exercises are performed.

Severe Neonatal Skin Infection: Clinical Case

Background. Pyoderma is the most common skin infectious disease of early age, it is a group of dermatoses characterized by purulent-inflammatory damage to the skin, dermal appendages, and subcutaneous fat. The diagnosis is based on medical history and physical examination. The main treatment methods are antibacterial therapy (local or systemic) and antiseptic skin toilet. Some forms of deep pyoderma require surgical interventions.Clinical case description. Girl A., 14 days of life, was admitted to the neonatal department of infectious disease with complaints of the mass in the left shoulder joint area. Historical information: 27 years old mother was not observed in any maternity welfare centre; chorioamnionitis was revealed at admission to the obstetric hospital. She received broad-spectrum antibacterial therapy perinatally. A girl from spontaneous vaginal delivery born on the 39th week with body weight of 2700 g, body length of 50 cm, and APGAR score of 8/9, she was breastfed. The condition on admission was severe. There were multiple indurated rash elements (pustules with turbid fluid) on the skin of the chest, limbs, and back. Skin desquamation was noted. There was hyperemia area up to 3.5 × 1.5 cm in the left shoulder joint area, with soft-elastic consistency, fluctuation symptom was positive. Complete blood count has shown: leukocytosis and neutrophilosis. Methicillin-resistant Staphylococcus aureus (MRSA) was revealed in blood via PCR method, in hemoculture, and in throat and nose cultures. C-reactive protein level was increased. Abscess culture — MRSA. Screening by immunological assay was performed to exclude primary immunodeficiency. Abscess incision and drainage were performed; 5 mL of thick yellow-green pus was obtained. Combination therapy with broad-spectrum antibiotic was carried out.Conclusion. There was positive dynamics on the administered therapy: the child condition was satisfactory, skin cleared of infectious rash, abscess was sanitized, laboratory parameters normalized, the child had no fever.

PSAT182 Dilemmas in the Diagnosis and Management of Osteoporosis in a patient with Alkaptonuria: Successful Treatment with Teriparatide

Abstract Introduction Diagnosis and management of osteoporosis in patients with alkaptonuria can be challenging. Coexisting arthritis involving the lumbar spine (LS) and hips can falsely elevate bone density making DXA interpretation difficult. We report a patient with alkaptonuria who was successfully treated with teriparatide in addition to bisphosphonate therapy. Case History A 69-year-old female presented for evaluation of osteoporosis. She was diagnosed with alkaptonuria at age 29 when she reported bilateral conjunctival hyperpigmentation. She was also diagnosed with arthritis requiring left knee joint replacement at the age of 57 years. Subsequently, she underwent left hip, right knee, right hip, and left shoulder joint replacement surgeries. She also sustained fragility fractures in the foot and a 2-inches height loss. Physical examination: normal vital signs. Examination of eyes and ears: bluish black discoloration of the conjunctiva and ear lobes. Heart examination showed normal S1, split S2, and IV/VI systolic murmur over the right parasternal border; the rest of the physical examination revealed limited joint movements of thoracic and lumbar spines, wrists, ankles, knees and hip joints. Laboratory: serum PTH 33 pg./mL, 25-OH vitamins 28 ng/mL, 1,25 (OH)2 vitamin D 43 pg/mL, osteocalcin 11.6 mg/mL (ref 9.4-47.4), collagen cross-linked C-telopeptide 318 pg/mL (ref 104-1008), tyrosine 79.1 umol/L (ref 31.1-118.1), 24 hours urine homogentisic acid 4.2 gms (ref 20-30 mg). Genetic testing: compound heterozygous mutation for the HGD C. 496T2T>C and HGD C.1102A < G (p.mev368Va) variants, consistent with a diagnosis of alkaptonuria. DXA scan done at the age of 56 years showed osteoporosis (T score -2.7 femoral neck, 1.8 total hip, 2.5 LS). Patient was started on alendronate 70mg PO weekly for 5 years in addition to nitisinone. While on alendronate, she sustained fragility fractures of the right radius and left ankle. After 5 years of alendronate, the patient was transitioned to teriparatide 20-mcg subcutaneously (SC) daily for 2 years followed by annual intravenous zoledronic acid. For the subsequent 7 years, the patient led a healthy, active life with no fractures. Follow-up DXA showed improvement to the osteopenic range at the radius site as degenerative arthritis made interpretation of other sites impossible.This case illustrates the challenges in the diagnosis and treatment of osteoporosis in patients with alkaptonuria. DXA can be ineffective in this condition due to the hip and LS arthritis. Measurement of trabecular bone scoreS and CT of the LS may be better alternate choices. Bisphosphonates alone are typically not effective in preventing fragility fractures in this population but use of teriparatide may be an effective treatment. Further studies are needed to assess the effectiveness of teriparatide in this population but our case shows promise that this treatment result in BMD improvement and fracture prevention. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

SAPHO Syndrome: About an Observation and Review of the Literature

Introduction: SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) is autoinflammatory rheumatism of the spondyloarthritis group. It is rare, it prevalence is 1/10000 inhabitants. The average age at diagnosis is 38 years, with no gender predominance, first described by Chamot and colleagues in 1987. Objective: To present observation and review of the literature on SAPHO syndrome which is rarely diagnosed in our daily practice. Observation: This was a 28 year old female patient, Senegalese, living in Dakar, followed in obstetrics gynecology for the desire of maternity, the family context of sickle cell disease who consulted for diffuse mechanical and articular inflammatory pains involving the proximal interphalangeal (IPP) of the left 5th toe, the left shoulder, the sternocostal and dorsolumbar joints evolving for 3 years. The clinical examination found: A painful swelling with a visual analog scale (VAS) of 6/10 of the right sternocostal joint and of the interphalangeal joint (IP) of the right hallux, diffuse acne, no palmoplantar pustulosis, no psoriasis, no gluteal or talalgia. The biology shows an inflammatory syndrome (VS at 37 mn at the 1st hour and CRP at 41mg/l), a decrease of 25-OH-Vitamin D3 at 22 ng/ml (N: 25-30 ng/ml), the positive latex test, Ac anti-CCP: 43 IU/ml (N < 5 IU/ml), positive Ac anti-HBc , Ac anti HBs > 1000 IU/l on the other hand blood calcium, blood phosphorus, G6PD, PTH, TSH us, free T4, anti ECT Ac, HLA-B27 Ag with no particularities. The scintigraphy showed hyper fixation of the right 1st toe, sacroiliac joints, dorsolumbar spine, left shoulder, manubrium sternal junction, and bilateral sternoclavicular junction realizing a classical bull horn image in SAPHO syndrome. Because of this clinical and paraclinical manifestation helped by the 1994 diagnostic criteria of Kahn at 1/3 (chronic joint involvement associated with severe acne), the SAPHO syndrome was retained and the treatment instituted after the normal pre-therapeutic analysis and systematic deworming was: Salazopyrine 2000mg/day (dosage reached by increments of 500 mg/week); Uvedose (vitamin D3 ) 100000 IU / month; bisphosphonates 70 mg /week and paracetamol + codeine 1g x 2/day as needed for 3 months with a favorable follow-up by the regression of signs (pain VAS at 2/10). Conclusion: The SAPHO syndrome is the prerogative of the young adult subject, bone scintigraphy is very valuable for its diagnosis, its better knowledge would avoid diagnostic and therapeutic erratic. Keywords: SAPHO syndrome, bone scan, Dakar, Senegal.

Tumoral calcinosis in the periarticular soft tissue of the left shoulder joint secondary to end‑stage renal disease.

Tumoral calcinosis in the periarticular soft tissue of the left shoulder joint secondary to end‑stage renal disease.

Management of frozen shoulder by leech therapy and adjuvant phytotherapy

BACKGROUND: Frozen shoulder is also known as adhesive capsulitis. It is one of the common musculoskeletal disorders. Its common symptoms such as pain and restricted movement of the shoulder joint. Conventional management of frozen shoulder include oral analgesics, range of motion exercises, intra- capsular corticosteroids injection, local application of analgesic oils and ointments but no such effective results have been found yet. As per Ayurveda perspective the condition can be correlated with Avabahuka. Further, Jalaukavacharana (~leech therapy) is one of the ancient para-surgical procedure described in Ayurveda for treatment of variety of such inflammatory condition along with other para surgical procedure and internal herbal drugs. METHODOLOGY: A 52 -year female patient having chief complaints of pain with restricted movement of left shoulder joint, pain in cervical region radiating towards left shoulder joint and mild tingling sensation on lower back region, was clinically diagnosed as case of frozen shoulder. This patient was treated with specific regimen such as Jalaukavacharana (~leech therapy) locallyalong with Ashwagandhaghanvati and Panchatikta ghrita guggulu internally. The parameters observed for prognosis were pain, stiffness, range of movements. Therapeutic evaluation of treatment was done based on improvement in the symptoms.

A Patient With Rheumatoid Arthritis Who Developed Pasteurella Multocida Arthritis Without Animal Contact; Case Report

Pasteurella species are immobile, non-sporeless, gram-negative coccobacilli that can be found in the respiratory tract and gastrointestinal tract flora of pets and can cause various infections with cat-dog bites. While it usually causes cellulitis and abscesses, clinical pictures such as septic arthritis, osteomyelitis, pneumonia, endocarditis, sepsis and meningitis can also be seen in immunosuppressed patients. Here, a case of septic arthritis due to Pasteurella multocida, which developed in the left shoulder joint of a 70-year-old female patient with a history of rheumatoid arthritis, diabetes mellitus, and hypertension, without animal contact or trauma, is presented in the light of the literature.

Effectiveness of elongation band exercise on the upper limb strength and range of motion among older adults.

An elongation band (EB) is used to improve the physical strength of older adults. However, the evidence of its effect on the upper limb is a deficiency. This study investigated the effectiveness of EB exercises on upper limb function in the elderly. Participants were divided into two groups: EB (n=16) and control (n=14). The EB group performed exercises in a sitting position using an EB while the control group performed active stretching exercises without bands. The exercise regimen consisted of four shoulder joint movements. Each group performed the exercise for 20 min per day, 5 days per week over a period of 2 months. Measurements included upper limb muscle strength, shoulder joint range of motion, and grip strength. Measurements were performed at baseline, and 1 and 2 months after the intervention. Analysis of covariance was used to compare differences between the groups. The EB group demonstrated significant increases in muscle strength (upper trapezius, deltoid, middle trapezius muscle), shoulder joint range of motion (right shoulder flexion, internal rotation, external rotation, left shoulder joint extension), and grip strength. In conclusion, EB exercises increased upper limb muscle strength, shoulder joint range of motion, and grip strength in older adults.

A case of rheumatoid arthritis with bilateral shoulder bursitis accompanied by gas image.

We experienced a case of bilateral shoulder bursitis with gas images in a rheumatoid arthritis (RA) patient. A 60-year-old man with RA had been treated with weekly methotrexate 10 mg and daily prednisolone (PSL) 10 mg for 7 months. Generalized pain, especially in the bilateral shoulder joints, developed and exacerbated daily with increased C-reactive protein (CRP) level. Despite the initiation of biweekly sarilumab 200 mg, joint symptoms and CRP level continued to worsen. Computed tomography (CT) scan to determine the cause of severe shoulder inflammation revealed low absorption areas with contrast effects at the margins around the bilateral shoulder joints, accompanied by internal gas images. In addition, magnetic resonance imaging demonstrated subacromial bursae and coracoid bursae and bursitis, leading to the suspicion of abscess formation depending on the presence of gas image. In spite of antimicrobial therapy, arthralgia did not improve, and a CT-guided arthrocentesis of the left shoulder joint resulted in negative findings of infection in culture and pathological examinations. Switching treatment to intensive anti-inflammatory therapy with high-dose steroids and etanercept finally improved symptoms and CRP levels associated with the reduction of low absorption areas and disappearance of gas images at bilateral shoulder joints. Our case indicated that bursitis with gas image in RA patients involves unusual pathophysiology and requires intensive anti-rheumatic treatment.

Dancers utilize a ‘whip-like effect’ to increase arm angular momentum during multiple-revolution pirouette en dehors

ABSTRACT A pirouette en dehors (PeDh) is multiple turns using the angular momentum generated by swinging the arms with both feet on the ground. The purpose of this study was to investigate how the arm swing facilitates increasing peak angular momenta of both arms during multiple PeDh. Upper body movements in single to six-revolutions clockwise (as seen from above) PeDhs were analysed to determine arm’s angular momentum induced by the individual joint torque, gravitational force and motion-dependent terms. The horizontal abduction and adduction torques of the right and left shoulder joints, respectively, and clockwise torsional torque of the upper torso induced the clockwise angular momentum (CWAM) of the arms in the horizontal plane, about the vertically upward axis. The motion-dependent term induced the CWAMs after joint torques and contributed to the maximum total CWAM of both arms substantially. The CWAMs induced by the motion-dependent term increased with joint torques up to the triple PeDh in the right arm but independently from the left shoulder joint torque up to the sextuple PeDh in the left arm. Using a whip-like motion of the arm, increasing the arm joint torques would not be required necessarily when performing, i.e., more than quaruple PeDhs.