Pain-free Range Of Motion Research Articles

Poster 130: Incidence and Treatment Characteristics of Coracoclavicular Ligament Injuries with Associated Lateral Clavicle Fractures in a Military Population

Objectives: To identify the demographics and characteristics of lateral clavicle fractures treated with coracoclavicular ligament repair or reconstruction, as well as to the subsequent postoperative complications. Methods: The United States Military Health System Data Repository was queried for patients with a Current Procedural Terminology (CPT) code for coracoclavicular ligament reconstruction between October 2013 and March 2020. Radiographs were evaluated for the presence of a lateral clavicle fracture at the time of initial injury and classified based on the modified Neer classification. The electronic health records to include operative reports and clinical notes were then reviewed for patient demographics, operative technique, and clinical course. Results: A total of 965 patients underwent coracoclavicular ligament repair or reconstruction between October 2013 and March 2020. Forty patients (4.6%) were identified with concomitant lateral clavicle fractures. The mean age of 29.575 years (SD 10.1) of which 85% male and 80% were active duty. Based on the Neer classification, there were three type I, 18 type IIB, 12 type III, and seven type V. Twenty-two of these injuries were addressed acutely (55%), while 18 were managed chronically (45%). Open reduction internal fixation of the distal clavicle was performed in 16 of the 40 patients (40%). An equivalent distribution of concomitant coracoclavicular ligament repair versus reconstruction was performed amongst the forty total patients. Postoperatively, two patients went on to nonunion and seven patients had loss of coracoclavicular reduction. Five patients returned to the operating room for removal of symptomatic hardware (3), revision (1), and irrigation and debridement (1). At the conclusion of their fracture care, five (12.5%) of patients necessitated medical separation from the military. Conclusions: A small subset of coracoclavicular reconstructions performed in the military occur for a concomitant lateral clavicle fracture. The majority of military patients who underwent coracoclavicular ligament repair or reconstruction in the setting of a lateral clavicle regained full, pain-free range of motion. Although malunion and nonunion are known complications of this injury pattern, only two patients went on to develop these complications. However, postoperative complications were common, occurring in 25% of patients. At the conclusion of their fracture care, five (12.5%) of patients necessitated medical separation from the military.

Visual feedback manipulation in virtual reality to influence pain-free range of motion. Are people with non-specific neck pain who are fearful of movement more susceptible?

Movement-evoked pain may have a protective or learned component, influenced by visual cues which suggest that the person is moving towards a position that may be perceived as threatening. We investigated whether visual feedback manipulation in virtual reality (VR) had a different effect on cervical pain-free range of motion (ROM) in people with fear of movement. In this cross-sectional study, seventy-five people with non-specific neck pain (i.e., neck pain without a specific underlying pathology) rotated their head until the onset of pain, while wearing a VR-headset. Visual feedback about the amount of movement was equal, 30% smaller or 30% larger than their actual rotation. ROM was measured using the VR-headset sensors. The effect of VR manipulation in fearful (N = 19 using the Tampa Scale for Kinesiophobia (TSK) and N = 18 using the Fear Avoidance Beliefs Questionnaire-physical activity (FABQpa)) and non-fearful (N = 46; non-fearful on both scales) people was compared using mixed-design ANOVAs. Fear of movement, influenced the effect of visual feedback manipulation on cervical pain-free ROM (TSK: p = 0.036, ղp2 = 0.060; FABQpa: p = 0.020, ղp2 = 0.077); a greater amplitude of pain-free movement was found when visual feedback reduced the perceived rotation angle compared to the control condition (TSK: p = 0.090, ղp2 = 0.104; FABQpa: p = 0.030, ղp2 = 0.073). Independent of the presence of fear, visual feedback manipulation reduced the cervical pain-free ROM in the overstated condition (TSK: p< 0.001, ղp2 = 0.195; FABQpa: p<0.001, ղp2 = 0.329). Cervical pain-free ROM can be influenced by visual perception of the amount of rotation and people with fear of movement seem to be more susceptible to this effect. Further research in people with moderate/severe fear is needed to determine whether manipulating visual feedback may have clinical applicability to make patients aware that ROM may be influenced more by fear than tissue pathology.

MICRO-FRAGMENTED ADIPOSE TISSUE IN THE SUCCESSFUL TREATMENT OF RECURRENT ROTATOR CUFF TEARS IN AN INJURED WORKER

This is the case of a 42-year-old right-handed male truck cargo mechanic who suffered a rotator cuff (RTC) tear of his right shoulder after a slip and fall while at work. An MRI of the shoulder demonstrated supra-spinatus and infraspinatus tendon tears. After a trial of 4 months of nonoperative treatment, he underwent arthroscopic repair of his RTC. Postoperatively, he completed a course of physical therapy (PT) and a work conditioning program. Unfortunately, he had ongoing pain, limitations in range of motion (ROM), and functional limitations, which prevented him from returning to work. A repeat MRI demonstrated a retear of supraspinatus and infraspinatus tendons. After consulting with the author, he underwent a micro-fragmented adipose tissue injection under ultrasound guidance into the involved tendons. After 4 weeks of additional PT, he was noted to have full, pain-free ROM with normal strength and was able to return to his full work duties, including overhead lifting without restrictions.

Immediate response to injection is associated with conservative care outcomes at 12 weeks in subacromial shoulder pain

BackgroundSubacromial injection is known to influence pain of subacromial origin, yet its association with conservative care outcomes is unknown. This study investigated whether immediate response to subacromial injection of corticosteroid and local anaesthetic is associated with conservative care outcomes at 12 weeks post injection and/or progression to surgery. Designprospective prognostic cohort study. MethodsSixty-four participants with subacromial related shoulder pain attending initial orthopaedic outpatient appointment at an Australian public hospital, received subacromial injection of corticosteroid and local anaesthetic followed by up to 12 weeks of physiotherapy. Immediate response to injection was measured by change in shoulder range of motion (ROM) and pain immediately (within 20 min) before and after injection. The Shoulder Pain and Disability Index (SPADI) was measured at baseline, 6 and 12-weeks. ResultsBackward stepwise linear regression revealed immediate post-injection improvement in pain-free ROM (p = 0.001) and higher baseline symptoms (p = 0.016) were significantly associated with better 12-week SPADI outcomes. Longer symptom duration (p = 0.029) and higher age (p = 0.013) were significantly associated with poorer outcomes. Only 11 individuals progressed to surgery. The resultant model could explain 35% of the variation in change in SPADI at 12 weeks. ConclusionImprovement in pain-free shoulder ROM immediately post injection is significantly associated with better 12-week conservative care outcomes. This information, derived from within consultation injection responses, could help inform decisions about potential treatment options. Further research with higher numbers and longer-term patient-reported outcomes could further clarify these findings. RegistrationAustralia and New Zealand Clinical Trials Registry 21 May 2012: 12612000532808.

Clavicular reconstruction utilizing free fibula flap with periosteal extension

Clavicular reconstruction is typically managed conservatively. Despite demonstrating improving outcomes, including range of motion and pain, there are currently no published reports of acute reconstruction with vascularized free fibula flaps (VFFF) or vascularized periosteal extensions in adult patients with clavicular defects. VFFFs have been utilized to correct critical bony defects of the clavicle and chronic nonunions; however, descriptions following acute trauma are rare. Bony union enhancement with periosteal extension has been described in both pediatric and adult populations, but never in the case of clavicular reconstruction. Herein, we seek to fill this gap in the literature by describing the acute reconstruction of a 6.5cm bony gap in a 29-year-old male following a gunshot wound to the chest, utilizing a 6.5cm VFFF with periosteal extension, and inset to the internal mammary vessels. The postoperative course was uncomplicated, with bony consolidation noted by 10 weeks, and full, pain-free range of motion at 8 months, showing this technique may be a viable option following acute trauma.

Conservative Physiotherapy Treatment of Femoroacetabular Impingement

Abstract The femoro-acetabular impingement (FAI) syndrome is a motion-related disorder of the hip joint with premature contact between the acetabulum and the proximal femur. It is a relatively new clinical entity and no strict treatment protocols and guidelines have been established yet. Furthermore, patients are often misdiagnosed and not properly treated. We report a clinical case of a young adult female patient presenting with a bilateral FAI-CAM type deformity during the last 2 years. An individual progressive global elastic resistant training program was established which involved stimulation to all affected muscle groups using Pilates concept. Hip-specific and functional lower limb strengthening targeted the deep hip external rotators, abductors and flexors in the transverse, frontal, and sagittal planes. Improving the dynamic stability and Core stability was the main aim of the challenging physiotherapy treatment in this case. A good functional result was registered at 6 months follow up. All therapeutic activities were performed in a pain free range of motion which was of paramount importance for achieving excellent patient compliance and successful outcome respectively. The applied treatment strategy demonstrated to be reliable and could be a helpful tool in the armamentarium of contemporary physiotherapy when dealing with the FAI group of patients.

Subacromial Impingement Syndrome: A Systematic Review of Existing Treatment Modalities to Newer Proprioceptive-Based Strategies.

Musculoskeletal pain is a common reason for primary care visits, with many visits for shoulder pain due to subacromial impingement syndrome (SIS). Current treatments lack evidence for effective management, showing only temporary outcomes. This systematic review evaluates existing modalities in comparison to the use of more permanent proprioceptive-based strategies. Specifically, this meta-analysis compared the use of kinesiology tape, myofascial trigger point release (MPTR), scapular stabilization exercises (SSE), and resistance training. PubMed, BioMedCentral, and ScienceDirect databases were queried for studies evaluating proprioceptive-based exercises in the last nine years. In total, 48 studies met the inclusion and exclusion criteria. After removing duplicates, a total of 14 level 1 studies were left. Kinesiology tape use demonstrated a statistically significant reduction in pain-free range of motion. MPTR improved in all pain scores and the disability scores index. SSE also reduced pain; however, mixed results were seen for range of motion. Finally, resistance training not only reduced pain but improved proprioception and joint position sense. Even though all techniques showed some promise in treating SIS, further large-scale studies exploring related outcomes are needed.

Arthroscopic Dorsal Ligamentocapsulodesis in the Treatment of Isolated Lunotriquetral Interosseous Ligamentous Injury: A Retrospective Case Series of 22 Patients.

Background: The literature is scarce regarding isolated tears of lunotriquetral interosseous ligament (LTIL). The purpose of this study was to present mid-term clinical and functional results of arthroscopic dorsal ligamentocapsulodesis in the treatment of isolated LTIL tears. Methods: Twenty-two patients (8 females, 14 males; mean age: 31 years; age range: 18-42) with isolated LTIL tears verified by wrist arthroscopy were retrospectively reviewed and included in the study. The mean follow-up was 55 months (range: 24-84). The modified Mayo wrist score, visual analog scale (VAS), flexion and extension deficits of passive wrist range of motion (ROM), pain-free ROM with forced wrist extension and grip strength were measured in all patients preoperatively and at final follow-up. Results: The mean modified Mayo wrist score significantly improved from 50 ± 10.29 preoperatively (range: 30-65) to 86 ± 11.61 (range: 60-100) at the final follow-up (p < 0.001). The mean VAS score significantly improved from 7.1 ± 0.83 (range: 6-8) preoperatively to 2.2 ± 1.35 (range: 0-6; p < 0.001) at the final follow-up. At the final follow-up examination, the forced wrist extension was painless in all but three patients who developed pain at 70º, 75º and 80º of extension, respectively. The mean strength of hand grip significantly increased from 38.6 ± 9.68 (range: 24-54) kg to 49.5 ± 12.36 (range: 33-66) kg at the final assessment (p < 0.001). No major complications were observed during or after the procedure. Conclusions: With the encouraging mid-term outcomes and a lower complication rate, arthroscopic LTIL dorsal ligamentocapsulodesis seems to be a safe and effective surgical technique in improving functional outcomes and reducing pain in patients with isolated LTIL tears. Level of Evidence: Level IV (Therapeutic).

Local infiltration analgesia improves functional outcome after total knee arthroplasty: A randomized controlled trial

Background: Total knee arthroplasty (TKA) may be associated with severe postoperative pain, which requires prolonged hospital stay to provide effective analgesia. Increasing postoperative pain is associated with increased hospital stays and readmissions, lower patient satisfaction, longer time to rehabilitation and physiotherapy milestones and diminished range of motion (ROM). Purpose: This randomized controlled trial compared the functional outcome following the use of local infiltration analgesia (LIA) with combined spinal epidural analgesia (CSEA) versus CSEA alone in patients undergoing primary unilateral osteoarthritis of the knee. Methods: Between December 2017 and June 2019, a total of 30 patients undergoing primary unilateral TKA were included in the study. The patients were randomized into two groups, 15 patients each. Patients in Group A were administered LIA intraoperatively while patients in Group B were not. Both groups were given CSEA as their primary modality of anesthesia. Primary outcome was ROM of knee on 1st, 5th, and 14th postoperative days. Secondary outcomes were pain assessment using visual analog scale score on 6th, 24th, and 48th h postsurgery, total opioid consumption in 1st 48 h, and duration of hospital stay. Results: Mean ROM at 1st, 5th and 14th day was significantly higher in Group A compared to Group B (P < 0.05 for all). Mean pain score at 6 h, 24 h, and 48 h was significantly higher in Group B compared to Group A (P < 0.05 for all). Mean total opioid consumption was significantly higher in Group B (455.20 ± 38.84 g) compared to Group A (325.73 ± 50.18 g) (P < 0.001). Mean duration of hospital stay was significantly higher in Group B (7.07 ± 0.96 days) compared to Group A (5.73 ± 0.59 days) (P < 0.001). Conclusion: LIA provides significant pain relief in the early postoperative period and hence is associated with higher patient satisfaction. LIA also allows early and improved pain-free ROM at knee and contributes to achieving rehabilitation milestones earlier. It significantly reduces opioid requirement and thus reducing opioid-related side-effects.

Kinesio Tape 14-Day Application Cycle: A Case Study

This study utilized a 14-day application cycle of Kinesio tape which is a longer version of the current application period with the goal to extend the effect of the treatment on the immediate effect on perceived pain, pain free range of motion, overhead squat analysis, and the athlete’s perceived performance. Kinesio Tape was applied to the athlete for five days, and then removed for a two-day rest period and then repeated. Pre/post-assessments consisted of an overhead squat analysis, pain free range of motion of the hip, knee, and ankle, perceived pain, and perceived performance. There was a significant increase in pain free range of motion for two of the eight joint actions assessed [left hip internal rotation (p=0.03) and left ankle plantarflexion (p&lt;0.01)]. Furthermore, participants significantly improved their overhead squat assessment score from pre (5.4±1.8) to post (3.5±1.8) Kinesio Taping (p&lt;0.01). Lastly, participants reported a significantly lower level of perceived pain (p&lt;0.01) and a significantly higher level of perceived performance (p&lt;0.01) after the usage of Kinesio Tape.

Immediate Effects of Myofascial Release Technique on Muscle Flexibility, Vertical Jump Height in Recreational Badminton Players

Introduction: In the life of a normal human function or in doing activity of daily living muscular flexibility plays an important role. Flexibility is the ability of a joint or series of joints to move through an unrestricted, pain free range of motion. A limitation in the muscular flexibility leads to several musculoskeletal overuse injuries in players life and remarkably affect a person’s level of function. Myofascial Release (MFR) is a manual soft tissue technique that is frequently used in physical therapy for the flexibility purpose. Aim: To find out the immediate effects of MFR on muscle flexibility, vertical jump height in recreational badminton players. Materials and Methods: This was a case control study design with total of 60 recreational badminton players were recruited for the study during July 2018 to May 2019 for 10 months. All the subject was assigned into three groups as per the selected muscle like quadriceps, hamstring and calf muscle. Vertical jump height Knee flexion angle Popliteal Angle (PA) distance from the wall (Lunge test) was measured pre-intervention and post intervention. MFR technique was applied as an intervention. Paired sample t test was used to find out the immediate effect. Results: Quadriceps and hamstring play a significant effect in vertical jump height and the flexibility of the muscles increases after the administration of MFR. Vertical jump height for quadriceps group (p&lt;0.029) showed extremely significant improvement. Flexibility of quadriceps (p&lt;0.001), hamstring (p&lt;0.001) and calf (p&lt;0.001) also showed significant differences. Conclusion: The study concluded that MFR has immediate effect on increasing muscle flexibility and muscle power.

Evaluation of results of surgical management of lateral tibial condyle fractures using locking compression plate

Introduction: Tibial plateau fractures are the common injuries that may be associated with poor outcomes and a high rate of complications. The problem rise significantly in high energy trauma and severe soft tissue injuries. Locked compression plating system has clear biomechanical advantages and avoids iatrogenic tissue damage when compared with conventional plating. The purpose of surgical management is to restore and preserve normal knee function. It can be accomplished by anatomical restoration of articular surfaces, maintaining mechanical axis, restoring ligamentous stability and preserving a functional pain free range of motion of knee. Materials and Methods: This is a prospective study of 36 patients with tibial plateau (Schatzker type I, II and III) fractures fixed with lateral locking compression plate over lateral surface of tibia and followed for a minimum period of 6 months and evaluated by using Rasmussen knee score system. Results: All patients were followed properly but two patients were lost to follow up so only remaining 34 patients were finally evaluated for functional outcome. Mean age of patient was 38.8 years with range of 19 to 70 years. All fractures united by average of 17.5 weeks (range 14-25 weeks) with delayed union observed in 6 cases. Three patients had wound dehisence, three varus deformity, one deep vein thrombosis, four arthritis and five cases of each knee joint pain & stiffness. According to Rasmussen's scoring system, 52.94% patients had excellent results, 32.35% patients had good, 8.22% fair and 5.88% poor result. Conclusions: Locking plates are good option for lateral tibial condyle fractures with minimum complications. Anatomical reduction can be easily maintained with locking plates, which also helps in early mobilization and hence obtaining good functional outcome in tibial condylar fractures. Keywords: Tibial plateau fractures, Schatzker (type I, II and III) classification, Locking compression plate, Rasmussen knee score

Kinesiotaping for the Rehabilitation of Rotator Cuff-Related Shoulder Pain: A Randomized Clinical Trial.

Kinesiotaping (KT) has been widely used in clinical practice. Current evidence is insufficient to support the use of KT for treating rotator cuff-related shoulder pain (RCRSP), as its mid- and long-term effects have not been investigated. Individuals using KT will achieve faster improvements in symptoms and functional limitations compared with those not using it. They will also present a greater increase in pain-free range of motion (ROM) and acromiohumeral distance (AHD) at the end of the treatment. Randomized controlled trial (NCT02881021). Therapy, level 1b. A total of 52 individuals with RCRSP, randomly assigned to 1 of 2 groups (experimental: KT; control: no-KT), underwent a 6-week rehabilitation program composed of 10 physical therapy sessions. KT was added to the treatment of the KT group. Symptoms and functional limitations were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire (primary outcome); Brief Pain Inventory (BPI); and Western Ontario Rotator Cuff (WORC) index at baseline, 3 weeks, 6 weeks, 12 weeks, and 6 months. AHD, pain-free ROM, and full ROM were measured at baseline and at week 6. The effects of KT were assessed using a nonparametric analysis for longitudinal data. No significant group × time interactions (0.112 ≤ P ≤ 0.726) were found for all outcomes. Time effects were observed as both groups showed significant improvements for all studied outcomes (DASH, BPI, and WORC, p < 0.0001; AHD, p = 0.017; pain-free ROM, p < 0.0001; and full ROM abduction, p ≤ 0.0001). Whereas symptoms, functional limitations, ROM, and AHD improved in both groups, the addition of KT did not lead to superior outcomes compared with exercise-based treatment alone, in the mid and long term, for individuals with RCRSP. Clinicians should not expect supplementary mid- or long-term gains with KT to reduce pain, improve shoulder function and ROM, or increase AHD if a rehabilitation program focusing on shoulder neuromuscular control is concurrently provided as treatment for individuals with RCRSP.

Study of surgical management of proximal tibial fractures using anatomical proximal tibia locking compression plate

Introduction: Ever since the advents of high velocity transport system, there is an alarming increase in road traffic accident (RTA) with increased orthopaedic related morbidity and mortality. Proximal tibia being involved in body weight transmission through knee joint and leg, it plays a vital role in knee function and stability. The aim of surgical treatment of proximal tibial fractures is to restore and preserve normal knee function, which can be accomplished by anatomical restoration of articular surfaces, maintaining mechanical axis, restoring ligamentous stability and preserving a functional pain free range of motion of knee. Treatment of these injuries using minimally invasive percutaneous plate osteosynthesis (MIPPO) techniques may minimize soft tissue injuries and damage to vascular integrity of fracture fragments. Materials and Methods: This study was a hospital based prospective study centered in department of orthopedics at GSL Medical College Rajahmundry, from December 2017 to May 2019 in which 20 patients with proximal tibia fractures were treated with locking compression plate (LCP). Results: The assessment of clinical outcome was made according to Rasmussen’s functional grading system. End results showed excellent outcome and out Of 20 patients, 19 Patients (85%) showed radiological UNION. Conclusion: Surgical management of proximal tibial fractures will give excellent anatomical reduction and rigid fixation to restore articular congruity, help to facilitate early mobilization and reducing post-traumatic osteoarthritis and hence to achieve optimal knee function. LCP remains a good choice in comminuted or more severe patterns of fractures.

Factors determining the range of motion in primary total knee arthroplasty

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Total knee arthroplasty (TKA) ­­­­­­is one of the most successful surgical procedure with over 90% survival rate at 10 to 15 years. It provides a stable, pain free range of motion (ROM) for day to day activities. The aim of this study is to evaluate various factors determining ROM after TKA.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 348 patients with 390 knees treated with TKA using cruciate retaining (CR) and posterior stabilized (PS) prosthesis were included and analysed. Mean follow up period was 18 months. Patients were analysed for factors like age, sex, diagnosis, body mass index (BMI), pre-operative exercises, ROM, deformity, posterior femoral condylar offset (PFCO), posterior tibial slope (PTS), post-operative rehabilitation and implant design (CR vs PS). Statistical analysis of above factors on knee ROM was done. Patients were assessed pre-operatively, at 6 weeks, 3, 6, 12 and 18 months post-operatively.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Age and sex did not affect the final ROM. The mean knee ROM improved from 86.87° to 96.95°. Factors like BMI, deformity had negative correlation and Pre-operative diagnosis, exercises, knee scores, good preoperative ROM, PFCO, PTS had positive correlation on ROM.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Pre-operative exercises, diagnosis, ROM, deformity, BMI, PFCO and PTS were important factors which influence ROM in TKA. Patient selection and preoperative counselling are important for good clinical outcome.&lt;/p&gt;

Acute Symptoms on Rotator Cuff Calcific Tendinitis is Effectively Relieved by Ultrasound Guided Percutaneous Needle Lavage Procedure: a Case Report

Introduction:Rotator cuff calcific tendinitis (RCCT) frequently manifests as acute shoulder pain during the acute resorptive phase. Pain typically worse at night and limited range of motion (ROM) with muscle spasm. Several treatment options have been proposed. In this case, a single needle ultrasound-guided percutaneous lavage (UGPL) combined with corticosteroid subdeltoid bursa injection (SDBI) with a good outcome.Case Presentation:A Female, 59 years old, presents with left RCCT acute pain (VAS 7/10) for 2 days and limited painful shoulder ROM. Inflammation and local tenderness found on the left shoulder, ultrasonography shows calcification in the left infraspinatus tendon with sub-deltoid bursa fluid. Patient in sitting position, ultrasound probe placed at long axis of infraspinatus tendon. Using a 23G needle 5 ml syringe, 1% lidocaine infiltrated until the needle penetrates the calcification site. Then a small amount of normal saline (NaCl) with lidocaine injected in a pulsating manner, observed until chalky matter backflows, mixed with NaCl in the syringe. Repeat this procedure until chalky backflow is minimal. Finally, 10 ml of Triamcinolone Acetonide 40 mg mixed with 2 ml lidocaine 2% SDBI using the same needle. Dramatic shoulder pain relieve (VAS 2/10) is immediately achieved after the procedure. One week follow up, the patient is pain-free and regains full ROM of her left shoulder.Discussion:Several methods are proposed for the treatment of acute RCCT, including corticosteroid injection and arthroscopy debridement. UPGL is an attractive option because it is minimally invasive, can be performed in-office setting, and pain relief is obtained immediately by decompressing and removing inflamed calcified sites.Conclusion:The treatment in acute pain RCCT using UGPL combined with corticosteroid SDBI provides a good outcome.

Early Active Motion Versus Sling Immobilization After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial

To compare the effect of early mobilization (EM) with standard rehabilitation (SR) over the initial 24months following arthroscopic rotator cuff (RC) repair. A total of 206 patients with full-thickness RC tears undergoing arthroscopic repair were randomized following preoperative assessment of shoulder range of motion (ROM), pain, strength, and health-related quality of life (HRQOL) to either EM (n= 103; self-weaned from sling and performed pain-free active ROM during the first 6weeks) or SR (n= 103; wore a sling for 6weeks with no active ROM). Shoulder ROM, pain, and HRQOL were reassessed at 6weeks and 3, 6, 12, and 24months postoperatively by a blinded assessor. At 6, 12, and 24months, strength was reassessed. At 12months, ultrasound verified RC integrity. Independent t tests assessed 6-week group differences and 2-way repeated measures analysis of variance assessed changes over time between groups. The groups were similar preoperatively (P > .12). The mean age of participants was 55.9 (minimum, 26; maximum, 79) years, and 131 (64%) were men. A total of 171 (83%) patients were followed to 24months. At 6weeks postoperatively, EM participants had significantly better forward flexion and abduction (P < .03) than the SR participants; no other group differences were noted. Over 24months, there were no group differences in ROM after 6weeks (P > .08), and pain (P > .06), strength (P= .35), or HRQOL (P > .20) at any time. Fifty-two (25%) subjects (30% EM; 33% SR) had a full-thickness tear present at 12-month postoperative ultrasound testing (P > .8). EM did not show significant clinical benefits, but there was no compromise of postoperative ROM, pain, strength, or HRQOL. Repair integrity was similar at 12months postoperatively between groups. Consideration should be given to allow pain-free active ROM within the first 6weeks following arthroscopic RC repair. Level I, high-quality randomized controlled trial.

The effect of intraarticular injection of botulinum toxin type A, triamcinolone or saline plus rehabilitation exercise shoulder pain on patients with post-stroke

Shoulder pain is the most common complication of post-stroke, which occur up to 60% patients with post-stroke. The aim of our research is to study the effect botulinum toxin type A and triamcinolone for shoulder pain on patients with post-stroke. Seventy-five patients with shoulder pain on post-stroke patients were randomly divided into three groups based on difference of injection (A:BoNT-A, B: triamcinolone, C: saline). Each group was injected once with ultrasound guidance. All groups received therapeutic exercise up to 4 weeks. The Evaluation of Fugl-Meyer assessment (FMA), Visual Analogue Scale (VAS) and pain-free range of motion (ROM) were recorded for pain and quality of life at baseline and end of 4th week after injection. The FMA of upper-limb were significantly improved in group A and group B patients between baseline and end of 4th week ( P < .05). The VAS score in group A and group B significantly decreased from 6.9 ± 1.1 (baseline) to 2.7 ± 1.4, and from 6.3 ± 1.2 (baseline) to 4.4 ± 1.2 at 4 weeks ( P < .05) respectively. The passive ROM and active ROM were significantly improved in group A and group B patients between baseline and 4 weeks ( P < .05). The between-group comparison revealed significant differences in group A and group B, group B and group C with regard to the FMA of upper-limb, VAS score and ROM at 4 weeks ( P < .05). No changes were observed for the group C after intervention. No adverse events were occurred in all group patients. The all treatments can significantly reduce shoulder pain and recovery function in patients with stroke, but BoNT-A combined with physical therapy seems to affect better for such patients.

Correlation between Improvement in Pain Free Range of Motion of Shoulder and Different Functional Scores Following Trigger Point Injection in Myofascial Pain Syndrome Involving Upper Back

Correlation between Improvement in Pain Free Range of Motion of Shoulder and Different Functional Scores Following Trigger Point Injection in Myofascial Pain Syndrome Involving Upper Back

Acute Rotator Cuff Tears due to Low Voltage Electrical Injury: A Case Report

Since shoulder have a higher proportion of muscle which would have low electrical resistance, there could be more electrical damage to the rotator cuff muscles. We present a patient with acute rotator cuff tear by sudden uncontrolled jerking contractions caused by an electrical shock. A case of 42-year-old man with acute rotator cuff tear due to electrical injury to the shoulder was presented. Magnetic resonance imaging showed a full thickness tear and an undulating appearance of the peripheral end of the torn supraspinatus and infraspinatus muscle, suggesting an acute complete rupture. By arthroscopic surgery, the torn rotator cuff tendons were repaired with a suture bridge technique. At the final follow-up, the patient had a full, pain-free range of motion and had fully recovered shoulder muscle power.