Normal Shoulder Research Articles

Angle measurement stability and cycle counting accuracy of hours-long duration IMU based arm motion tracking with application to normal shoulder ADLs

BackgroundInertial measurement units are increasing used for monitoring joint motion, but there is a need to demonstrate their suitability during hours-long continuous use, as well as a need for validated methods to count arm cycles and provide descriptions of typical cycles. Research questionDo IMU sensors and rainflow counting have sufficient accuracy for tracking and cycle counting of hours-long continuous arm motion? If so, what are the cycle rates of normal arm ADL and is there a representative cycle that can serve as a ‘gait cycle’ for the arm? MethodsIMU sensors continuously tracked a robot performing 8 h of simulated cyclic arm motion. Error in the angle measurements was regressed against time to determine the rate of error and the total accumulated error. Additionally, the cycle count accuracy of rainflow, peak/valley, and Fourier transform counting methods was evaluated. ResultsOver 8 h the IMU measurements accumulated a maximum 0.473° of error and the rainflow method counted cycles with less than 1% error. Applying rainflow counting to normal shoulder ADL resulted in an average rate of 533 elevation cycles per day.Tabulating the ADL cycles by mean and range values into a matrix and calculating the centroid, the single best values representing arm elevation cycles were a mean of 22.4° and a range of 21.6°. SignificanceIMU sensors can track arm motion for 8 h with little increase in error, though during longer durations error may reach unacceptable levels. For normal arm ADL, the rainflow determined count of arm elevation full-cycles differed from previous estimates based on peak/valley counting. From the rainflow counting, a single cycle representation of cycle mean and range was determined that can be used as a ‘gait cycle’ for the shoulder

Interest of arthroscopic distal clavicular resection in shoulder pain after rotator cuff repair and healing

To evaluate outcomes of secondary distal clavicle resection (DCR) in patients that had failed conservative treatment of symptomatic ACJ arthropathy following isolated rotator cuff repair (RCR) with complete tendon healing. Between 2008 and 2018, the senior surgeon performed isolated RCR in 1935 patients, of which 23 (1.2%) presented with ACJ pain and discomfort at ≥ 6 m following index RCR, despite complete healing of repaired tendons. Those 23 patients underwent secondary DCR as ACJ arthropathy was confirmed clinically and radiographically. Clinical assessment before DCR included subjective shoulder value (SSV) and pain at rest. Clinical assessment at > 12 months after DCR included SSV, pain at rest, Constant-Murley score and range of motion. Study design: case series, level III. Of the initial cohort of 23 patients, 5 were lost to follow-up, leaving 18 patients aged 53.3 ± 7.6 years (range, 39–68) for outcome assessment. None of the patients had complications or ACJ instability following DCR. At a mean follow-up of 7.0 ± 3.1 years after DCR, the SSV improved to 76.1 ± 20.2, the pain at rest decreased to 2.8 ± 1.9. At final follow-up, the Constant-Murley score was 64.7 ± 20.5. Secondary DCR for symptomatic ACJ arthropathy following isolated RCR reduced pain in only 67% of patients, though 94% were satisfied and would undergo secondary DCR again. It is worth noting that residual pain is common following RCR, which does not always restore normal shoulder function.

Involvement of inflammatory lipoproteinemia with idiopathic adhesive capsulitis accompanying subclinical hypothyroidism.

Thyroid functional abnormalities are considered risk factors for idiopathic adhesive capsulitis (IAC) though that relationship remains uncertain. Although dyslipidemias are associated with IAC, no readily accessible study has reported associations between dyslipidemias and IAC patients with subclinical hypothyroidism. The purposes of this study were to investigate whether subclinical hypothyroidism is an independently associated factor for IAC and to determine the differences in prevalence of dyslipidemias between two groups of persons with subclinical hypothyroidism: one composed of IAC patients and the other of individuals without IAC. This case-control study included a case group of 412 IAC patients without intrinsic shoulder lesions, extrinsic causes, or medication for thyroid dysfunction. The control group comprised 1236 age- and sex-matched persons seeking general checkups at the authors' health promotion center during the same period as the case group. Control subjects had normal shoulder function and no previously diagnosed adhesive capsulitis, no medication for thyroid dysfunction, and no history of trauma or of shoulder surgery. The studied variables were age, gender, obesity, diabetes, dyslipidemias, subclinical hypothyroidism, hypothyroidism, and hyperthyroidism. A conditional logistic regression analysis evaluated the matched sets of subjects to determine odds ratios and 95% confidence intervals for the studied variables. The differences in the prevalence of dyslipidemias between IAC patients with subclinical hypothyroidism and individuals with subclinical hypothyroidism but without IAC were determined with generalized estimating equations, using covariates of age, sex, and diabetes. The P values were set at < 0.05. Subclinical hypothyroidism (odds ratio, 2.10; 95% confidence interval, 1.36-3.15; P=.001) was significantly associated with IAC. Patients with IAC and subclinical hypothyroidism had a significantly higher prevalence of hyper-low-density lipoproteinemia, an inflammatory lipoproteinemia, than individuals with subclinical hypothyroidism but without IAC (P=.002). Subclinical hypothyroidism is significantly associated with IAC. Hyper-low-density lipoproteinemia, an inflammatory lipoproteinemia, is involved in IAC accompanied by subclinical hypothyroidism.

Revealing the Inner-relevance of College Students' Physical Fitness by Association Analysis and Neural Network.

The physical activity and health status of the students in China are not optimistic, there is a general lack of exercise volume and exercise intensity. Normal college students shoulder the future of China's education. Promoting their physical health is the basic requirement for cultivating teachers in the new era; Methods:Testing and recording 1123 male, 3266 female college students' physical fitness indicators in a normal college, the relationship between these indicators was mined by correlation analysis and Apriori, and the intelligent prediction models was constructed according to the mined knowledge; Results: There was no correlation between male 1000m running and vital capacity (P > 0.05), but it was correlated with vital capacity weight index (P < 0.05); Most indicators of women showed varying degrees of correlation. There are many association rules between female 50m sprint and standing long jump, sit-ups, and BMI. The introduction of vital capacity weight index slightly improved the accuracy of the 1000m run prediction model; The prediction model of female 50m sprint with standing long jump, sit-ups and BMI as inputs not only keeps the accuracy in a reasonable range, but also reduces the complexity and parameters; ConclusionsFor male students, the ostensibly paradoxical relationships between vital capacity and a 1000 meter run and between vital capacity and pull up were actually due to body shape; Body shape, lower limb explosive power, and core strength play key roles for female college students' speed quality; BMI, standing long jump and one minute sit-up can be used to predict the 50m sprint performance of general female college students.

Assessment of a painful non-traumatic shoulder by radiography paired to ultrasound: a series of 222 cases

Context and objective. Chronic shoulder pain is a common reason for outdoor parients in rheumatology. Magnetic Resonance Imaging (MRI), which is its main diagnosis tool, is not accessible for the majority of Congolese patients. The objective was to describe diseases that lead to non-traumatic shoulder pain (NTSP) using the radiography-ultrasound pair and to assess the performance of X-ray compared to that of ultrasound. Methods. This is a cases series of 222 patients for whom an X-ray and an ultrasound were carried out for an NTSP at the Gombe imaging center in Kinshasa and at the Intercommunal Hospital of Fécamp in France, during the period from January 2015 to October 2016. The variables of interest were demographic, clinical, radiographic and ultrasound data. Results. Two hundred and twenty-two patients were included in the study, including 113 women (50.9%) and 109 men (49.1 %). The mean age of the patients was 55.7 ± 14.3 years. A normal shoulder was observed in 122 patients (55 %) on the radiography versus 48 (21.6 %) on the ultrasound. Tendinopathies, calcifications and acromio-clavicular arthropathy were the most common forms of NTSP. The X-ray was more informative than ultrasound for the diagnosis of capsulitis and subacromial conflict. In all other cases it was less effective than ultrasound. The sensitivity and negative predictive value of X-ray were lower than that of ultrasounds. Conclusion. The coupling of X-ray with ultrasound helps to diagnose a greater number of entities than if we considered each examination in isolation. Ultrasound presented a better diagnosticu performance than standard radiography.

Combined Margin Convergence Repair and Subacromial Balloon Spacer for the Treatment of Massive Rotator Cuff Tears

Background: Current joint-sparing treatment options for massive, irreparable rotator cuff tears aim to prevent superior migration of the humeral head and maintain the subacromial space. Although options such as superior capsular reconstruction and posterosuperior tendon transfer may appropriately restore function and reduce pain, these procedures harbor significant comorbidity and intense postoperative rehabilitation. Recently, studies have demonstrated excellent results from a subacromial balloon spacer composed of a biocompatible copolymer that degrades over the 12 months following implantation. This spacer enables a more anatomic position of the humeral head to restore normal shoulder biomechanics. Indications: The subacromial balloon spacer is primarily indicated in patients with massive, irreparable rotator cuff tears who demonstrate proximal humeral migration. Contraindications include subscapularis or teres minor tendon tears, deltoid dysfunction, and pseudoparalysis. Technique Description: Standard arthroscopic portals are established, and a diagnostic arthroscopy is performed to assess the glenohumeral joint space and subscapularis tendon. A subacromial bursectomy is performed without proceeding medial to the superior glenoid rim. The subacromial space is measured utilizing an arthroscopic measurement probe to ensure that the selected spacer will lie slightly medial to the glenoid. The rotator cuff is then reapproximated from the lateral to medial aspect of the tear and repaired via a side-to-side manner with high strength, nonabsorbable tape, and a self-capturing suture device. Following repair, the deployment device is inserted through the lateral portal, placed slightly medial to the glenoid, and inflated with saline. Results: Utilization of the described subacromial balloon augmentation provides significant pain relief by restoring glenohumeral biomechanics, improvements in range of motion, and an enhancement in quality of life. Discussion: This case report and video review of a technique for utilizing a subacromial balloon spacer demonstrates an effective, simple, and safe treatment for massive, irreparable rotator cuff tears. Positive results rely on appropriate inflation and secure fixation. Recent clinical trial data suggest that functional outcomes for the subacromial balloon spacer are noninferior to that of partial rotator cuff repair. These promising results suggest that the subacromial balloon spacer may prove an essential tool for joint-preserving surgery following massive, irreparable rotator cuff tears.

Scapular Kinematic During Arm Elevation in Shoulder Impingement Syndrome Using Motion Analysis System: A Systematic Review and Meta-analysis

Context: With a key role in normal shoulder function, scapular kinematics have been investigated in shoulder impingement syndrome (SIS). Objectives: This systematic review aimed at determining scapular kinematic patterns in patients with SIS compared to in asymptomatic individuals. Data Sources: Databases such as PubMed, Scopus, Web of Science, Ovid, Embase and PEDRO were searched from January 1995 to June 2021. Study Selection: Articles in English published in peer-reviewed journals and using motion analysis systems to compare scapular kinematics between patients with SIS and asymptomatic subjects during arm elevation were included. Data Extraction: A modified Downs and Black checklist was used to assess the risk of bias of the included studies. A random-effects model was employed to perform a meta-analysis. Results: Nine out of 1650 screened abstracts were included for data extraction. Scapular upward rotation significantly decreased during arm elevation in SIS (SMD = -0.13, 95% CI = -0.23 to -0.02) with a low effect size (I2 = 46%). No differences were observed in scapular posterior tilt (SMD = -0.07, 95% CI = -0.18 to 0.03) and external rotation (SMD = 0.02, 95% CI = -0.06 to 0.09) between patients with SIS and asymptomatic subjects. Conclusions: This review revealed that except for scapular upward rotation, scapular movement was generally insignificantly different between the subjects with and without SIS during arm elevation. Between-group differences might have been overlooked as a result of the high risk of bias in the included studies. The high-quality studies addressing confounders are required to provide a definitive conclusion on the relationship between SIS and scapular kinematics.

Evaluation of the Differences in the MRI Findings Related to Primary and Secondary Adhesive Capsulitis.

Purpose: The aim of this study is to describe the radiological findings of adhesive capsulitis due to different etiological factors and reveal that different clues due to different etiological causes should be considered in the diagnosis of adhesive capsulitis. Methods: The study group comprised 24 primary and 22 supraspinatus tendon rupture-related adhesive capsulitis patients with 24 individuals without adhesive capsulitis and with normal shoulder magnetic resonance imaging. Independent samples t-test and one-way analysis of variance tests were used to compare the measurements between the groups. Paired sample t-test and Cohen's kappa statistic were used to determine inter-observer reliability. The chi-squared test was used to determine the relationships between groups and categorical variables. Study participants were evaluated both qualitatively and quantitatively. Quantitative measurements included the thickness of the humeral and glenoid segment of the joint capsule and the thickness of the anterior joint capsule and the fluid depth within the biceps tendon sheath. The qualitative assessments included the detection of any signal abnormality at the rotator interval, the grading of the humeral and glenoid segment of the joint capsule, and the detection of any signal abnormality in respect of the anterior joint capsule. Results: A statistically significant difference was found between the groups of patients with primary adhesive capsulitis and with supraspinatus tear-related adhesive capsulitis in terms of the thickness of the humeral segment of the joint capsule at the axillary recess level (AUC = .729) (P: .006). Furthermore, setting the cutoff value for the thickness of the humeral segment of the capsule to 4.6mm allowed the differentiation of primary adhesive capsulitis and supraspinatus tear-related adhesive capsulitis with a sensitivity of 70.8% and a specificity of 87.3%. Conclusion: In conclusion, the humeral segment of the joint capsule thickness at the axillary recess was found to be affected by different degrees depending on whether it is a primary or supraspinatus tear-related adhesive capsulitis.

Identification of Diagnostic Magnetic Resonance Imaging Findings in 47 Shoulders with Subcoracoid Impingement Syndrome by Comparison with 100 Normal Shoulders.

BACKGROUND The aim of this study was to identify the diagnostic magnetic resonance imaging (MRI) findings in 47 shoulders with subcoracoid impingement syndrome by comparison with 100 normal shoulders. MATERIAL AND METHODS The subcoracoid impingement syndrome group consisted of 47 shoulders with subcoracoid impingement syndrome and the normal group consisted of 100 normal shoulders. The MRI parameters - coracoids-humeral distance (CHD), coracoid index (CI), height of the lesser tuberosity (HLT), coracoid obliquity (CO), coracoglenoid angle (CGA), coracohumeral angle (CHA), width of the subscapular tendon (WST), and contact distance between subscapular tendon and coracoid process (CD) - were compared between the subcoracoid impingement syndrome group and the normal group. The areas under the curves (AUCs) from the receiver operating characteristic (ROC) for single MRI parameters were recorded, in which the MRI parameters with AUC exceeding 0.70 were included in the analysis of combined parameters. Comparisons of ROC were made among single parameters and combined parameters. RESULTS For diagnosing subcoracoid impingement syndrome by using single MRI parameters (CHD, CI, HLT, CGA, CHA, WST, and CD), the AUCs were 0.963, 0.806, 0.745, 0.691, 0.613, 0.685, and 0.614, respectively, of which CHD had the largest AUC. CHD, CI, and HLT (AUC exceeding 0.70) were included in the study of the combined parameters. The AUC of combined CHD and HLT showed a significantly larger AUC than that of CHD (0.986 vs 0.963, P=0.036), and showed no significant difference compared with that of combined CHD, CI, and HLT (0.986 vs 0.987, P=0.882). CONCLUSIONS Measurement of the coracoid-humeral distance and height of the lesser tuberosity were key MRI diagnostic findings for subcoracoid impingement syndrome.

The InSpace Balloon: Useful Augmentation or First-Line Therapy?: Commentary on an article by Nikhil Verma, MD, et al.: "InSpace Implant Compared with Partial Repair for the Treatment of Full-Thickness Massive Rotator Cuff Tears. A Multicenter, Single-Blinded, Randomized Controlled Trial".

The InSpace Balloon: Useful Augmentation or First-Line Therapy?: Commentary on an article by Nikhil Verma, MD, et al.: "InSpace Implant Compared with Partial Repair for the Treatment of Full-Thickness Massive Rotator Cuff Tears. A Multicenter, Single-Blinded, Randomized Controlled Trial".

Description and Validation of the Anterior Glenoid Angle: A Novel MRI-Based Measure of Glenoid Morphologic Features and Version.

The goal of this study was to establish a normal value for, and evaluate the reliability of, a new measurement of glenoid morphologic features using magnetic resonance imaging: the anterior glenoid angle. A total of 90 magnetic resonance imaging scans of patients without shoulder arthritis were reviewed. The anterior glenoid angle of each glenoid was measured by 4 blinded physicians. The images were randomized and measured again. Finally, the Friedman angle was measured on the same images for reference. Descriptive statistics and inter- and intraclass correlation coefficients were calculated. The mean anterior glenoid angle was 60.4°±3.6°. Of the measured values, 77% were between 56° and 64°. Intraobserver reliability was very good to excellent in single measure (range, 0.763-0.901) and mean measure (range, 0.865-0.948) comparisons. Interobserver reliability was very good to excellent in both single measure (0.769) and mean measure (0.964) comparisons. The mean Friedman angle was 10.2°. Correlation between the anterior glenoid angle and Friedman angle ranged from a moderate negative (-0.496) to a strong negative correlation (-0.711) among the observers. The mean anterior glenoid angle measured via magnetic resonance imaging scan was 60.4° in normal shoulders, and more than 75% of the values were within 4° of the mean. The anterior glenoid angle has excellent inter- and intrarater reliability without using computed tomography scan or including the entire scapula in the field of view. The anterior glenoid angle has a good to very good negative correlation with the Friedman angle because decreasing anterior glenoid angles indicate increasing retroversion. [Orthopedics. 2022;45(6):361-366.].

Poster 173: Using Dynamic Digital Radiography to Measure Variation in Scapulohumeral Rhythm of Pathologic Shoulders

Objectives:Patients with various shoulder pathologies suffer from diminished range of motion and scapulohumeral rhythm (SHR), defined as the ratio of the respective contributions of glenohumeral and scapulothoracic motion to arm elevation. While previously challenging to measure SHR in a clinical setting, a novel technique known as Dynamic Digital Radiography (DDR) provides a safe and cost-effective method to directly evaluate aberrancies in motion. The purpose of this study was to measure the SHR of pathologic shoulders using Dynamic Digital Radiography (DDR).Methods:Shoulders were prospectively analyzed using DDR via obtaining a series of pulsed radiographs at up to 15 Hz of the joint in motion. Scapulothoracic motion and glenohumeral motion were quantified based on DDR images (figure 1). Measurements were taken in humeral abduction at 0-30°, 30-60°, 60-90°, and full abduction using the Grashey view. SHR at different points was calculated by dividing humeral arc of motion by scapular arc of motion in each of the aforementioned ranges. ANOVA testing was conducted to analyze differences among treatment groups and post-hoc Tukey testing was utilized to identify the specific groups between which differences occurred. Pairwise t-testing was performed to isolate differences between preop and postop radiographs. An alpha of 0.05 was set for determining significance for all outcome measures.Results:121 shoulders were analyzed, including 40 controls, 13 small rotator cuff tears (SRT), 29 massive rotator cuff tears (MRCT), 16 adhesive capsulitis, and 23 glenohumeral osteoarthritis (table 1). The final angle calculations are displayed in Table 2. SHR for full arc of abduction differed significantly in patients with massive rotator cuff tear (1.91 ± 0.51), adhesive capsulitis (1.55 ± 0.13), and glenohumeral osteoarthritis (2.31 ± 1.03) compared to controls (3.39 ± 0.62). No statistically significant difference was found in overall SHR between small rotator cuff tear (3.04 ± 1.62) and controls (3.39 ± 0.62). When analyzed across 30-degree intervals of humeral abduction, there was a statistically significant lower SHR found at 0-30°, 30-60° and 60-90° of humeral abduction in MRCT, adhesive capsulitis and glenohumeral osteoarthritis patients compared to controls. No significant difference was found in the SHR of patients with SRCT compared to controls across all 30-degree intervals of humeral abduction. SHR changes across these intervals of humeral abduction are plotted in figure 2. Control patients had average overall humeral abduction range of motion of 103.40 ± 31.97° which was significantly larger compared to all included shoulder pathologies (MRCT: 75.75 ± 22.61, SRCT: 80.93 ± 20.71, adhesive capsulitis: 64.49 ± 27.02, osteoarthritis: 71.05 ± 34.88). During humeral abduction, control patients had average overall scapular range of motion of 32.57 ± 13.60 which was significantly smaller compared patients with a MRCT (45.57 ± 10.41) and adhesive capsulitis (64.49 ± 27.02). No statistically significant difference was found when comparing scapular range of motion during humeral abduction in patients with small rotator cuff tears (29.71 ± 12.91) and glenohumeral osteoarthritis (34.77 ± 17.52) compared to normal controls.Conclusions:DDR is sensitive enough to detect a lower SHR in massive rotator cuff tears, adhesive capsulitis, and glenohumeral osteoarthritis compared to normal shoulders. While SHR varies throughout the arc of motion, it remained drastically different these 3 pathologies compared to controls. Moreover, when isolating for humeral and scapular motion on DDR, all 4 pathologic shoulder conditions had decreased humeral abduction compared to normal controls. Patients with adhesive capsulitis and massive rotator cuff tear also had an increased reliance on scapular contribution to overall humeral elevation. Ultimately, further study and validation of this dynamic assessment of SHR has the potential to augment the diagnostic algorithm for various shoulder pathologies.Figure 1.Reference lines used for calculation of the humeral and seapular abduction ares. Measurements were taken in reference to a vertical line. Calculations were made in the neutral position, at initiation of abduction, 30℃, 60℃, 90℃ and full abduction.Table 1.Patient DemographicsTable 2.Relative contributions by glenohumeral (GH) and scapulothoracie (ST) joint girdle motion in pathologic shoulder compared to normal control Figure 2.SHR was calculated for each patient at 0-30, 30-60, and 60-90 degrees and plotted

Poster 118: The Accuracy of a Smartphone App in Measuring Shoulder Range of Motion

Objectives:Measuring shoulder movements, specifically range of motion (ROM) of the shoulder joint is an important clinical parameter related to glenohumeral disorders and for functional evaluation of the shoulder before and after treatment, which may include surgery. Currently shoulder ROM measurements are performed in an office setting by the provider or alternatively may be performed by a physical therapist, traditionally with the use of a goniometer. The purpose of this study was to determine the accuracy of a smartphone-based digital ROM tool in assessing active shoulder ROM, compared to traditional goniometry measured by a physical therapist in an office setting.Methods:A prospective, non-blinded study was conducted at a single institution (University of St. Augustine, Austin< TX). Thirty (30) eligible and consenting participants with normal shoulder ROM were recruited. Each participant self-assessed their active shoulder ROM using the smartphone App. A physical therapist concurrently measured each participant’s active shoulder ROM using a hand-held goniometer. This concurrent data collection was designed for greater efficiency and minimal bias. Forward flexion (FF), abduction (AB) external rotation (ER), internal rotation (IR) and extension (EX) were measured. Agreement between the smartphone App and goniometric measurements, as well as intra-rater reliability (precision) was assessed using intraclass correlation coefficients (ICC) and Limits of Agreement analysis. Each measurement was performed in duplicate to assess precision. Statistical analysis was performed using R (https://www.r-project.org/)Results:Data were analyzed for 60 shoulders (30 right, 30 left) from 30 participants (mean age was 31.4, 92% female.) The inter-rater reliability between the two methods was excellent for all movements, with ICC ranging from 0.9 to 0.96. For all movements except AB, the mean difference in the measurements between PT and App was less than 1.3 degrees, and the difference was within 6 degrees of the mean differences for 80% of the participants. For AB, the mean difference was 2.08, and the difference was within 15 degrees of the mean difference for 80% of the participants. The intra-rater reliability or precision ranged from good to excellent. For all movements except IR, both PT and App showed excellent intra-rater reliability (ICCs > 0.90). For IR, good intra-rater reliability (ICCs >= 0.75) was observed.Conclusions:These data provide evidence that the smartphone App can be a reliable and valid tool for measuring shoulder ROM. Smartphone Apps enable self-assessment of ROM by patients at the convenience of their home and allow for remote monitoring at zero visit cost to the patient.

Characteristics and Rehabilitation Training Effects of Shoulder Joint Dysfunction in Volleyball Players under the Background of Artificial Intelligence.

With the development of volleyball technology, the frequent competition, the fierce competition, and the increase of sports load, the requirements for the athletes' own body, intelligence, combat, heart, and skills are getting higher and higher. Volleyball is one of the most popular sports in the world. It attracts people all over the world with its strong team appeal and its own unique charm. This study mainly discusses the characteristics of shoulder joint dysfunction in volleyball players and the effect of rehabilitation training under the background of artificial intelligence. By sorting out the development process of artificial intelligence technology, it can be analyzed that artificial intelligence technology already has a certain knowledge reserve, can make corresponding mechanized feedback, and can make correct judgments based on experience in more complex situations. This study compared volleyball athletes with handicap and barrier-free shoulder joints and observed the characteristics of shoulder pain, stability, and flexibility caused by subacromial impingement syndrome. It also looked at whether subacromial impingement syndrome athletes differ in volleyball spiking sequence and mobilization and recruitment of muscle power during swing spikes compared to athletes with normal shoulder function in the full kinetic chain. According to the volleyball intelligent competition platform, the implementation and application of ideas such as data collection, result feedback, adjustment of training plan, implementation of training plan, and real-time monitoring are regularly monitored. On the one hand, through timely assessment and detection of shoulder function of volleyball players, functional training is carried out for weaknesses to prevent injury; on the other hand, after a mild injury occurs, timely targeted training should be taken to find and correct wrong actions, and strengthen the weak part of muscle strength, so as to reduce the probability of repeated injury and improve sports performance and athletic ability. In the new system, after collecting and sorting, testers can directly upload to the web page in the form of Excel for automatic filling, grasp the test information of athletes in time, generate automatic warning, and save time. The monitoring content determined by this study mainly includes three index systems, including load, training preparation performance, and recovery. According to the self-provided evaluation system of relevant test equipment and the experience of expert coaches, the evaluation standards for each index are formulated. There was a statistically significant difference in the scores between the rehabilitation group and the pre-rehabilitation group during the study (P < 0.05). This study attempts to find the characteristics and rules of FMS scores of women's volleyball players of different levels, so as to provide more targeted physical training for volleyball players, promote the all-round development of physical fitness, and avoid the risk of sports injuries. This study provides more effective and comprehensive recommendations for the prevention and recovery of shoulder injuries in volleyball players. This study provides more effective and comprehensive recommendations for the prevention and recovery of shoulder injuries in volleyball players. The results of the study can provide reference for the scientific training and rehabilitation of volleyball players and make suggestions for the treatment and prevention of subacromial impingement syndrome.

Evaluation of stiffness of rotator cuff tendons, coracohumeral ligament, tendon of long head of biceps and posterior capsule by strain and shear wave elastography in frozen shoulder vs normal shoulder

Background: Frozen shoulder is an idiopathic condition which presents with the loss of both active and passive movement at the shoulder joint over a period of time, associated with pain on movement. The wide range of clinical conditions with similar symptoms make the diagnosis difficult, hence making imaging studies mandatory. An increase in stiffness is noted by shear wave and strain ultrasound elastography of rotator cuff tendons, coracohumeral ligament, tendon of long head of biceps, posteriorcapsuleina patient affected with frozen shoulder. Objectives: To evaluate the stiffness of rotator cuff tendons, coracohumeral ligament, tendon of long head of biceps and posterior capsule in frozen shoulder by strain elastography and shear wave elastography and compare it with normal shoulder. Materials and Methods: The study was conducted with twenty-nine patients with frozen shoulder. Limited and painful motion without tendinitis or tendon tears were considered. in inclusion criteria. Strain and shear wave lastography were performed on rotator cuff tendons, coracohumer alligament, tendon of long head of biceps and posterior capsule on affected side and normal side to assess and compare the strain ratios and stiffness values on both sides. Receiveroperatingcharacteristiccurvaturewasplottedfortheobtainedvalues.

Shoulder Injury Related to Vaccine Administration (SIRVA) in 16 Patients Following COVID-19 Vaccination Who Presented to Chiropractic, Orthopedic, and Physiotherapy Clinics in Hong Kong During 2021

BackgroundShoulder injury related to vaccine administration (SIRVA) occurs when an intramuscular deltoid injection is administered into the shoulder joint. This observational study describes clinical features in 16 patients with SIRVA following Coronavirus 2019 (COVID-19) vaccination who presented to chiropractic, orthopedic, and physiotherapy clinics in Hong Kong between January 1, 2021, and January 1, 2022.Material/MethodsAdults age ≥18 with new-onset shoulder pain and imaging-confirmed shoulder pathology were retrospectively identified from 35 clinics. Patient demographics and clinical and vaccination details were extracted from the electronic medical record. Shoulder injury was determined by correlating clinical and imaging features.ResultsOf 730 patients with shoulder pain, 16 SIRVA cases (mean age, 49±10 years, 75% female) were identified; (12/16, 75%) of patients received the Pfizer-BioNTech vaccine while (4/16, 25%) received Sinovac-CoronaVac. The most common diagnosis was adhesive capsulitis (10/16, 63%), followed by bursitis (3/16, 19%) and supraspinatus tear (3/16, 19%). Mean symptom onset was 3.5±2.5 days post-vaccination, and always occurred after the 2nd or 3rd vaccination, involving reduced shoulder range of motion (ROM). Mean baseline pain was 8.1±1 (out of 10). All patients received conservative care (eg, exercise, manual therapies). At 3-month follow-up, mean pain reduced to 2.4±1.4; all patients had normal shoulder ROM.ConclusionsIn the past 2 years, millions of intramuscular COVID-19 vaccinations have been administered. It is important that clinicians are aware of SIRVA as a cause of new symptoms of shoulder injury and should ask the patient about recent vaccinations, including for COVID-19.

A finite element model of the shoulder: application to the changes of biomechanical environment induced by postoperative malrotation of humeral shaft fracture

ObjectivesThe humerus fracture is one of the most commonly occurring fractures. In this research, we attempted to evaluate and compare the extent of malrotation and biomechanical environment after surgical treatment of humeral shaft fractures.MethodsA finite element (FE) model of the shoulder was built based on Computed Tomography (CT) data of a patient with a humeral shaft fracture. The muscle group around the shoulder joint was simulated by spring elements. The changes of shoulder stresses under rotation were analyzed. The biomechanics of the normal shoulder and postoperative malrotation of the humeral shaft was analyzed and compared.ResultsDuring rotations, the maximum stress was centered in the posterosuperior part of the glenoid for the normal shoulder. The von Mises shear stresses were 4.40 MPa and 4.89 MPa at 40° of internal and external rotations, respectively. For internal rotation deformity, the shear contact forces were 7–9 times higher for the shoulder internally rotated 40° than for the normal one. For external rotation deformity, the shear contact forces were about 3–5 times higher for the shoulder with 40° external rotation than the normal one.ConclusionPostoperative malrotation of humeral shaft fracture induced the changes of the biomechanical environment of the shoulders. The peak degree of malrotation was correlated with increased stresses of shoulders, which could be paid attention to in humeral shaft fracture treatment. We hoped to provide information about the biomechanical environment of humeral malrotation.

Deep learning model for measurement of shoulder critical angle and acromion index on shoulder radiographs

Several bone morphological parameters, including the anterior acromion morphology, the lateral acromial angle, the coracohumeral interval, the glenoid inclination, the acromion index (AI), and the shoulder critical angle (CSA), have been proposed to impact the development of rotator cuff tears and glenohumeral osteoarthritis. This study aimed to develop a deep learning tool to automate the measurement of CSA and AI on anteroposterior shoulder radiographs. We used MURA Dataset v1.1, which is a large publicly available musculoskeletal radiograph dataset from the Stanford University School of Medicine. All normal shoulder anteroposterior radiographs were extracted and annotated by an experienced orthopedic surgeon. The annotated images were divided into train (1004), validation (174), and test (93) sets. We use pytorch_segmentation_models for U-Net implementation and PyTorch framework for training the model. The test set was used for final evaluation of the model. The mean absolute error for CSA and AI between human-performed and machine-performed measurements on the test set with 93 images was 1.68° (95% CI 1.406°-1.979°) and 0.03 (95% CI 0.02 - 0.03), respectively. A deep learning model can precisely and accurately measure CSA and AI in shoulder anteroposterior radiographs. A tool of this nature makes large-scale research projects feasible and holds promise as a clinical application if integrated with a radiology software program.

Bankart Repair With Transferred Long Head of the Biceps Provides Better Biomechanical Effect Than Conjoined Tendon Transfer in Anterior Shoulder Instability With 20% Glenoid Defect

To examine the biomechanical differences between labral repair with transferred conjoined tendon and transferred long head of the biceps tendon (LHBT) for anterior shoulder instability with 20% bone loss. Twelve cadaveric shoulders were tested in sequent 5 conditions: intact, 20% glenoid defect, Bankart repair, Bankart repair with transferred conjoined tendon (dynamic conjoined tendon sling, DCS), and with transferred LHBT (dynamic LHBT sling, DLS) at 60° of glenohumeral abduction and 60° of external rotation. The physiological glenohumeral joint load was created by forces applied to the rotator cuff, conjoined tendon, and LHBT. The glenohumeral compression force and range of motion were recorded before anteroinferior force application. The anterior, inferior, and total translations were measured with 20, 30, 40, and 50 N of anteroinferior force, respectively. Anteroinferior glenoid defect led to significant increase of humerus translation and decrease of glenohumeral compression force. DLS provided better resistance effect in both anterior-posterior and superior-inferior directions than DCS under high loading condition (40 N, P=.03; 50 N, P <.01). Both DCS and DLS procedures could further restore glenohumeral compression force with Bankart repair (Bankart repair: 32.1 ± 4.0 N; DCS: 36.7 ± 3.2 N, P < .01; DLS: 35.8 ± 3.6 N, P=.03). No range of motion restrictions were observed relative to the normal shoulder. Both the DLS and DCS techniques could reduce the anterior-inferior translation and partially restore the glenohumeral stability in anterior shoulder instability with 20% anteroinferior glenoid defect compared with Bankart repair. Under greater loading conditions, DLS provides better stability than DCS. Shoulder stability can be restored by DLS and DCS with low load. With greater shoulder stability requirements, DLS might be a better option than DCS for anterior shoulder instability with 20% bone loss.

Effect of Rounded and Hunched Shoulder Postures on Myotonometric Measurements of Upper Body Muscles in Sedentary Workers

Background: Shoulder pain is prominent among sedentary employees who make motions of the upper limbs on a regular basis. Rounded shoulder posture (RSP) and hunched shoulder posture (HSP) are the most common clinical postural misalignments. These causes the spine to bend and raise tension on the nerve roots, which has a negative impact on upper-extremity muscular strength and function. Therefore, this study was carried out to investigate the effect of RSP and HSP on the mechanical parameters of the upper body muscles in clinically asymptomatic sedentary workers. Methods: Twenty office workers with RSP, 20 with HSP, and 20 with normal shoulder posture (NSP) were matched for age, BMI, and type of job. Volunteers were split into groups based on photometric shoulder angle measurements. Mechanical properties such as muscle tone, stiffness, and elasticity of the upper trapezius, middle trapezius, posterior deltoid, and pectoralis major were assessed in sedentary postures. Results: The study revealed a significant decrease in muscle tone for the pectoralis major and a significant increase in muscle stiffness for the poster deltoid in both RSP and HSP as compared to NSP. Specifically, muscle tone decreased from 20.1 ± 4.0 to 12.4 ± 3.1 Hz (38.3%), (p ≤ 0.001) in RSP and from 20.1 ± 4.0 to 14.0 ± 4.8 Hz (30.3%), (p ≤ 0.001) in HSP. Muscle stiffness increased from 309.9 ± 70.7 to 348.15 ± 68.7 N/m (11%), (p ≤ 0.001) in RSP and from 309.9 ± 70.7 to 441.7 ± 45.9 N/m (29.8%), (p ≤ 0.001) in HSP. Conclusions: RSP and HSP have an impact on the tone, stiffness, and elasticity of upper body muscles in healthy asymptomatic sedentary workers. These postures, on a regular basis, may affect physical health and decrease workers’ productivity. In addition, it is recommended for sedentary workers to take regular breaks and attend training that could help improve their physical health.