Arm Pain Research Articles

Quality of life and aspects related nutrition in advance stages non-small cell lung cancer patients.

Background: The quality of life (QoL) associated nutritional symptoms among advanced non-small cell lung cancer (NSCLC) patients remains uncertain. This study aimed to assess the impact of nutrition-related symptoms (indicated by Patient Generated Subjective Global Assessment-PG-SGA) to QoL among individuals diagnosed with advanced NSCLC, utilizing the EORTC QLQ-LC13 tool. Methods: A cross-sectional study included 170 patients diagnosed with NSCLC (TxNxM1) with periodically chemotherapy treatment at Hanoi Oncology hospital were invited to the study. The PG-SGA and EORTC QLQ-LC13 were assessed by a dietitian. Results: Poor nutritional status related with decrease in QoL (p < 0.05). Cough and short of breath moderate-positively correlated with PG-SGA score, while pain, take medicine for pain and trouble swallowing were fairly correlated. The symptoms of cough up blood, sore mouth or tongue, tingling and hair lost had poor correlation with PG-SGA score. Loss of appetite and anorexia had poor negative correlation with short of breath and pain in arm or shoulder. Conclusions: QoL declined in advance stage NSCLC malnutrition patients. Nutrition-related symptoms had poor to fair correlation with QoL categories, which suggests the insufficiency on solely addressing nutritional symptoms to enhance QoL in this group.

Non-invasive skin autofluorescence of advanced glycation end-products in patients with degenerative cervical myelopathy.

To clarify the association between skin autofluorescence of advanced glycation end-products (AGEs) and clinical outcomes and pain in patients with degenerative cervical myelopathy (DCM). Consecutive patients with DCM were prospectively enrolled. AGEs assessed by skin autofluorescence (the AGE score) were examined at the middle fingertip in eligible patients. Patients were divided into lower AGE score (AGE-L) and higher AGE score (AGE-H) groups based on a cutoff AGE score of 0.54. Demographic data, laboratory data, maximum spinal cord compression (MSCC), clinical outcomes, such as Euro Quality of Life 5-Dimmension, Neck Disability Index, and Japanese Orthopaedic Association score, and Numerical Rating Scale (NRS) score for neck, arm, hand, leg, and foot pain were compared between the two groups. Multiple linear regression analysis was performed to assess the association between the AGE score and the NRS score for pain in the lower limbs. Of the 263 patients, 93 were included in this study (41 with the AGE-L group and 52 with the AGE-H group). Demographic data, laboratory data, MSCC, and clinical outcomes were comparable between the two groups. The AGE-H group had significantly higher NRS scores for leg and foot pain than the AGE-L group. Multiple linear regression analysis revealed that higher AGE scores were significantly associated with more severe pain in the lower limbs in patients with DCM. Noninvasive skin autofluorescence of AGEs may be a useful biomarker for pain symptoms in the lower limbs in patients with DCM.

Should We Operate on Octogenarians with Cervical Myelopathy or Radiculopathy?

Retrospective Cohort. Investigate the disparities between octogenarians and non-octogenarians undergoing cervical spine surgery regarding perioperative, and postoperative outcomes. As the population ages, the demand for elective cervical spine surgery among older, more active adults increases. However, concerns remain regarding the optimal management of older patients undergoing cervical surgery, given the potential complexities associated with advanced age, comorbidities, and physiological decline. While the safety and efficacy of cervical spine surgery in younger cohorts have been extensively studied, there is a paucity of literature specifically addressing outcomes in octogenarians. Octogenarians undergoing elective cervical spine surgery were propensity matched 3:1 to patients <80 years old by baseline neck and arm pain, surgical approach, and total instrumented levels. Primary outcomes of interest were postoperative complications, unexpected 90-day hospital readmissions and 12-month reoperation. Secondary outcomes were 12-month patient satisfaction and patient reported outcome measures (PROMs) at 3 and 12 months, including EuroQol-5D, modified Japanese Orthopaedic Association, neck disability index, and visual analog scale for neck and arm pain. There were 29 octogenarians and 87 nonoctogenarians identified. The mean age in each cohort was 82.4±2.2 vs. 59.1±11.1 years, respectively. There was no difference in postoperative complications (10.3% vs. 6.9%, P=0.548), 90-day readmission (10.3% vs. 6.9%, P=0.548), and 12-month reoperation (3.4% vs. 2.3%, P=0.736) between octogenarians and non-octogenarians. Similarly, octogenarians and nonoctogenarians experienced comparable 12-month patient satisfaction (65.2% vs. 55.3%, P=0.393), improvement in 3- and 12- month PROMs and MCID achievement. Postoperative complications, readmission, reoperation rate, patient satisfaction, and PROMs did not significantly differ between octogenarians and non-octogenarians undergoing cervical spine surgery. These findings suggest that age alone should not be a determining factor in surgical decision-making for elective cervical spine procedures, as octogenarians can achieve comparable outcomes to their younger counterparts.

Cage only or Cage with plate fixation in Anterior Cervical Discectomy and Fusion surgery - Analysis of a national multicenter dataset.

Anterior Cervical Discectomy and Fusion (ACDF) is a surgical technique that can be used to treat several conditions of the cervical spine. Small sized studies have reported differences in radiological findings between cage only and cage with plate fusion techniques but no differences in clinical outcome, hence, larger studies are needed. The aim of this study was to compare the outcomes of ACDF between cage only and cage with plate fixation. Retrospective study design on prospectively collected registry data PATIENT SAMPLE: Individuals treated for cervical degenerative radiculopathy, with ACDF using either cage only or cage with plate fixation were identified in the Swedish Spine registry (Swespine). Included individuals had available baseline and 1-year postoperative data for the Numeric Rating Scale (NRS) for neck and arm pain. Patient reported outcome measures (PROMs) included were NRS for neck and arm pain, Neck Disability Index (NDI), and EuroQol-Visual Analogue Scale (EQ-VAS). Complications reported by clinicians and patients were also available in the Swespine registry, as well as the degree of satisfaction at the 1-year follow-up. Outcomes at the 1-year follow-up were compared between the cage only or cage with plate groups. In a secondary analysis, one or two levels of surgery was compared between the groups. The number of patients that reached the Minimum Clinically Important Difference (MCID) in improvement after treatment was calculated and compared between the groups. The Mann Whitney-U test was used for continuous variables and the Chi2 test for categorical variables. The groups included 344 individuals instrumented with cage only, and 334 receiving cage with plate fixation. NDI improvement was -14.0 points (95% CI: -12.2-[-15.8]) in the cage only group and -17.9 points (95% CI: -16.1 - [-19.8]) points in the cage with plate group (p = 0.007). A lower rate of hoarseness post-operatively was reported by the cage only group (OR: 0.65 [0.45-0.93], p = 0.026). No differences were seen in other outcomes. Clinical improvement was seen in both groups, but the improvement of NDI was better in the cage with plate group and the rate of hoarseness was lower in the cage only group.

Radiotherapy Versus Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma: Final Results of the ORATOR Randomized Trial.

Radiotherapy (RT) and transoral robotic surgery (TORS) are both curative-intent treatment options for oropharyngeal squamous cell carcinoma (OPSCC). Herein, we report the final outcomes of the ORATOR trial comparing these modalities, 5 years after enrollment completion. We randomly assigned 68 patients with T1-2N0-2 OPSCC to RT (with chemotherapy if node-positive) versus TORS plus neck dissection (± adjuvant RT/chemoradiation). The primary end point was swallowing quality of life (QOL) assessed with the MD Anderson Dysphagia Inventory (MDADI). Secondary end points included overall and progression-free survival (OS, PFS), adverse events (AEs), and other QOL metrics. The primary end point has been previously reported (Nichols 2019). In this report, the median follow-up was 5.1 years (IQR, 5.0-5.3 years). MDADI total scores converged by 5 years and were not significantly different across the follow-up period (P = .11). EORTC QLQ-C30 and H&N35 scores demonstrated differing profiles, including worse dry mouth in the RT arm (P = .032) and worse pain in the TORS arm (P = .002). Grade 2-5 AE rates did not differ between arms (91% [n = 31] v 97% [n = 33] respectively, P = .61), with more neutropenia and hearing loss in the RT arm, and more dysphagia and other pain in the TORS arm based on grades 2-5 (all P < .05). There were no differences in OS or PFS. In conclusion, toxicity and QOL profiles differ in some domains between RT and TORS, but oncologic outcomes were excellent in both arms. Choice of treatment should remain a shared decision between the patient and their providers.

The Impact of Symptom Duration on Postoperative Outcomes in Patients Undergoing Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis.

The optimal timing at which patients should undergo Anterior Cervical Discectomy and Fusion (ACDF) surgery to achieve the best outcomes has not been determined. Given that patients may experience delays in care and that insurance companies often require a minimum of six weeks of conservative treatment before surgery, it is essential to determine the impact of symptom duration on outcomes following ACDF. To evaluate the impact of symptom duration on outcomes following ACDF surgery. Systematic review and meta-analysis. Medline, Embase and Cochrane Library were searched from inception through July 2nd, 2024 in accordance with the PRISMA guidelines. Data on Neck Disability Index (NDI), Visual Analogue Scale (VAS) for neck and arm pain, and Short Form-12 (SF-12) physical and mental component scores were extracted. Subgroup analyses were performed to compare the outcomes at 6-months, 12-months and 24-months cutoff time points. Mean differences with 95%CI were used for continuous data. Nine studies comprising 1,511 patients (48.64% female) with a mean age of 50.56±9.88 years were included in this study. All patients achieved improvements in NDI, VAS, and SF-12 following ACDF. The amount of improvement decreased as symptom duration increased with patients experiencing greater than 24 months of symptoms experiencing statistically significantly less improvement in NDI (8.70 vs. 18.93, p=0.03), VAS Neck (1.95 vs. 3.33, p=0.003), and VAS Arm (1.74 vs. 3.72, p<0.001) in comparison to patients with less than 24 months of symptoms. There were no statistically significant differences in outcomes at the 6 and 12 months cut off points between cohorts. Longer symptom duration is associated with worse outcomes compared to shorter symptom duration with statistically significant differences observed at the 24-month cutoff for NDI, VAS Arm, and VAS Neck scores. Patients with greater than 24 months of symptoms also failed to achieve clinically significant improvement in neck pain postoperatively. Given the lasting impact of disability and pain on patients, more studies should assess the impact of symptom duration on postoperative outcomes and at even shorter cut-off points.

Development and Validation of Diagnostic Models for Cervical Nerve Root Involvement Based on Items From the Patient Interview and Clinical Examination

OBJECTIVE: To develop and internally validate diagnostic models for cervical nerve root involvement based on patient interview and clinical examination items. DESIGN: Diagnostic predictive modelling study. METHODS: People with a suspicion of cervical nerve root involvement (i.e., radicular pain and/or radiculopathy) (N=134) were included. Three diagnostic models (i.e., patient interview items alone, clinical examination alone, and combined patient interview plus clinical examination) were developed using multivariable logistic regression analyses. For internal validation, we performed bootstrapping techniques (250 repetitions). The diagnostic accuracy (Area Under the Curve (AUC)) and explained variance (Nagelkerke’s r-squared) of the models were assessed. An AUC of 0.7 or higher was considered adequate. RESULTS: The patient interview model consisted of two items and showed an explained variance of 0.23 and an AUC of 0.74 (95%CI: 0.66-0.81) after bootstrapping. The clinical examination model consisted of 2 items and had an explained variance of 0.29, and an AUC of 0.77 (95%CI: 0.69-0.85) after internal validation. The combined model had an explained variance of 0.38 and an AUC of 0.82 (95%CI: 0.75-0.89) after bootstrapping and consisted of the Spurling test (odds ratio (OR): 8.0 (95%CI: 3.1-20.4)), ‘Arm pain worse than neck pain’ (OR: 4.8 (95%CI: 1.9-11.8)) and the patient-reported ‘Presence of paraesthesia and/or numbness’ (OR: 2.8 (95%CI: 1.0-7.8)). CONCLUSIONS: The combined model showed the best diagnostic accuracy to determine the likelihood of cervical nerve root involvement. External validation is required before implementing any diagnostic model.

Efficacy of Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty in the Treatment of Cervical Degenerative Disc Disease, Radiculopathy, and Myelopathy: A Systematic Review.

Cervical degenerative disc disease (DDD) is a condition in which the discs in the neck deteriorate, causing symptoms including neck and arm pain, muscle weakness, and incoordination. In severe cases, it can lead to nerve and spinal cord compression, resulting in radiculopathy and myelopathy. This review aimed to assess the effectiveness of two surgical treatments, anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA), for addressing cervical DDD, radiculopathy, and myelopathy. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search was conducted in the PubMed and BioMed Central databases, from January to March 2024. Thirty-one studies were included, comparing the outcomes of ACDF and CDA in patients with cervical DDD, radiculopathy, and myelopathy. Data were analyzed to evaluate outcomes such as the Neck Disability Index (NDI), pain levels, neurological status, incidence of secondary surgeries, range of motion (ROM) maintenance, and occurrence of adjacent segment disease. CDA demonstrated comparable or superior clinical success to ACDF. Both the techniques showed similar improvements in NDI, pain levels, and neurological status during medium- and long-term follow-ups. CDA had lower rates of secondary surgeries and adverse events related to surgery or implants compared to ACDF. It also demonstrated a lower incidence of adjacent segment disease and better ROM preservation. The evidence supports CDA as a safe and effective alternative to ACDF for patients with cervical DDD, particularly those who may benefit from motion preservation. However, further long-term, multicenter randomized controlled trials are needed to provide more definitive guidance for clinical practice.

Smoking Does Not Negatively Impact Outcomes Following Cervical Laminoplasty: A Quality Outcomes Database Study.

Retrospective cohort study. To assess the impact of smoking on outcomes following elective cervical laminoplasty for degenerative cervical myelopathy (DCM). The detrimental effect of cigarette smoking on cervical spinal fusion surgery outcomes is well documented. However, the impact of smoking on outcomes following nonfusion cervical spine procedures is unknown. One commonly utilized nonfusion technique for cervical decompression is laminoplasty. Adult smokers or nonsmokers who underwent primary elective laminoplasty for DCM were included. The propensity score (PS) was constructed for being a current smoker based on covariates. Only patients contained in the PS overlapped region were included in the analysis set. Patient-reported outcomes (PROs) at baseline and 12 months postoperation included Visual Analog Scale (VAS) neck and arm pain, neck disability index (NDI)%, EuroQol-5 Dimension (EQ-5D), and modified Japanese Orthopedic Association (mJOA) scores. Other outcomes included perioperative complications, 3-month readmissions/reoperations, and patient satisfaction. Wilcoxon and Pearson tests were used to compare outcomes between smokers and nonsmokers. The study included 132 patients: 30 were smokers (22.7%) and 102 were nonsmokers (77.3%). No significant differences were found at baseline between groups in demographics or medical history. Smokers had significantly worse baseline VAS neck pain (5.7±3.2 vs. 4.4±3.04, P=0.028) and arm pain (5.7±3.5 vs. 4.3±3.2, P=0.045) scores, but all other baseline PROs were not statistically different between groups. No differences were found between smokers and nonsmokers in any 12-month PRO, or in rates of perioperative complications, 3-month readmissions, or 3-month reoperations. On multivariable logistic regression analysis, smoking had no significant impact on any outcome of interest. Clinical and PROs following elective laminoplasty for DCM are not significantly different between smokers and nonsmokers. Laminoplasty should be considered a good surgical option in smokers presenting with DCM.

Clinical Outcomes Following Treatment of Cervical Spondylotic Radiculopathy With Cervical Posterior Decompression Using Unilateral Biportal Endoscopic Technique: A Single Center Retrospective Series of 20 Patients.

Unilateral biportal endoscopy (UBE) is a minimally invasive approach to treat cervical spondylotic radiculopathy (CSR), which is a common condition caused secondary to disc herniation, disc degeneration, uncal osteophytes, and other conditions manifesting as neuropathic radicular pain. Anterior cervical discectomy and fusion (ACDF) is the gold standard surgical technique for treating CSR. However, it has several disadvantages, including loss of mobile segment, adjacent segment degeneration (ASD), implant- and approach-related complications, and high hospitalization costs. The current study aimed to evaluate the safety and efficacy of UBE decompression for CSR. After obtaining IRB approval, a single-center retrospective study was undertaken. Included patients underwent UBE decompression for CSR with a minimum of 6 months of follow-up. Patient demographics, perioperative data, and length of hospital stay were reviewed. Clinical outcomes were assessed using VAS scores for neck and arm pain, and NDI scores were measure preoperatively and at 1 and 6 months after UBE decompression. A repeated analysis of variance test was performed to measure the difference between VAS and NDI scores. Twenty patients (M: 15, F: 5) with a mean age of 56.7 ± 10.2 years were included. The mean follow-up period was 8.4 ± 1.8 months. The mean surgical time was 64.3±10.6 minutes. The average length of hospital stay was 1 day. At the final follow-up, the mean VAS for arm pain improved from 6.4 ± 0.7 to 0.6 ± 0.5 (92% improvement) and the mean VAS for neck pain improved from 3.3 ± 0.4 to 2.0 ± 0.2 (40% improvement). NDI score improved from 23.2 ± 1.95 to 5.7 ± 0.6 at the final follow-up (75% improvement). There were no complications. UBE is a safe and effective surgical treatment option for patients with CSR with excellent clinical outcomes. Clinical relevance of this case series study is to demonstrate the safety and efficacy of the novel unilateral biportal endoscopic decompression of cervical spondylotic radiculopathy and its short term clinical outcomes.

Cervical Disc Arthroplasty for the Treatment of Adjacent Segment Disease after Anterior Cervical Discectomy and Fusion

Study Design. A retrospective chart review was conducted at a single institution. Objective. The purpose of this study was to investigate clinical outcomes of cervical disc arthroplasty (CDA) used for the treatment of symptomatic adjacent segment disease (ASD) developed after anterior cervical discectomy and fusion (ACDF). Summary of Background Data. A major clinical concern following ACDF is the development of ASD. ASD after ACDF is often treated with an additional fusion, but risks include pseudoarthrosis and further ASD. CDA is a motion preserving alternative that addresses these concerns, and therefore, has been proposed as an alternative treatment for ASD after ACDF. Methods. CDA patients with prior adjacent-level ACDF (n=120) were identified from a consecutive series of CDA patients at one institution. Pre- to post- CDA patient-reported outcome measures were compared using the paired Wilcoxon signed-rank test. Results. A total of 142 devices were implanted – 98 patients underwent a one-level CDA, and 22 patients underwent two-level CDA. The mean follow-up duration after CDA was 32.11 months. Neck pain, arm pain, and Neck Disability Index (NDI) scores significantly improved from the preoperative to postoperative timepoint (respectively: 6.14 to 3.02, 4.42 to 1.61, 44.28 to 28.62, all P&lt;0.001). In total, 7 patients underwent reoperation (5.83%). One of these patients underwent reoperation for pseudarthrosis at the level of ACDF following a hybrid procedure. The indications for index level reoperations (n=3) were foraminal stenosis, osteolysis, and postoperative hematoma. All patients with an adjacent level reoperation (n=3) received surgery at levels adjacent to the prior fusion, not the more recent CDA. Conclusion. The results of this study found CDA was effective for the treatment of ASD following ACDF. CDA appears to be a viable treatment option for ASD after ACDF in appropriately selected patients.

Abstract 4138529: Acute Coronary Syndrome in a Patient with Situs Inversus Totalis

INTRODUCTION: Situs inversus totalis (SIT) occurs in 1 in 8000 births. 0.04% of cases involve ACS, posing a clinical challenge. We present a case of NSTE-ACS in a patient with SIT, where a universal diagnostic catheter was used to engage the coronary arteries. CASE PRESENTATION: 51-year-old Caucasian male with situs inversus totalis presented with worsening right-sided chest&amp;right arm pain after shoveling snow. Initial examination was benign, but the EKG showed features of dextrocardia with T wave inversions in V2-V6. Laboratory results showed elevated CKMB (119.2)&amp;up-trending troponin T 1.260 ng/ml. He was started on a Heparin drip and 81 mg of Aspirin with a plan for urgent cardiac catheterization. A coronary angiogram from the right radial with a 6 French Tiger Radial Catheter in the right anterior projection (RAO) 30 degrees showed minor luminal irregularities in the RCA, and 90% stenosis in the LAD. RCA was enganged anticlockwise and LCA clockwise. A 6 French XB 3.5 guide catheter was used to engage the LCA system, and the mid-LAD was stented. DAPT including Aspirin and Ticagrelor, was initiated. A TTE showed an EF of 25-30% with severe anterior, apical, and septal wall hypokinesis. The patient was discharged home with GDMT for coronary artery disease. DISCUSSION: CAD in dextrocardia can be challenging, requiring reversed limb and precordial leads and a right-sided ECG to show the extent of MI. Failure to recognize dextrocardia can lead to underestimating or missing MI. Typical findings include global negativity in lead I, positively deflected QRS in aVR, negative P-wave in lead II, reverse R-wave progression in precordial leads, and right-axis deviation. Our patient's EKG revealed polarity reversal in leads I and aVL, QS and rS patterns in precordial leads, and positive polarity in aVR, suggesting dextrocardia with T wave inversions, prompting further workup. Engaging the coronary arteries is challenging. We used a Tiger radial catheter with a reverse torque technique: anticlockwise for the RCA and clockwise for the LCA. Both arteries were engaged in the right anterior oblique view at 30 degrees. The cranial and caudal angulation remained the same, but the standard left anterior oblique view was switched with the right anterior oblique view and vice versa. The double inversion technique is useful during interventions when dealing with unfamiliar anatomy. It is not well-established whether dextrocardia is a risk factor for myocardial infarction.

Abstract 4118076: Right Innominate Artery Endovascular Intervention Via Single Radial Access and Use Of Embolic Protection

Introduction: The occurrence of innominate artery stenosis is less prevalent compared to subclavian artery disease. Small studies suggest up to 8% of individuals initially diagnosed with suspected subclavian steal syndrome may present with innominate artery lesions. Deployment of an embolic protection filter within the internal carotid artery during percutaneous intervention of the innominate artery presents a solution to mitigate embolism. Case: A 70-year-old female with a history of peripheral vascular disease presented with claudication in both arms, manifested as pain in both arms. Her left subclavian was stented months prior to presentation. An aortogram revealed severe stenosis of the innominate artery (Figure 1). Since multiple attempts to cross the lesion antegrade from the femoral access site were unsuccessful, we proceeded with the successful deployment of an embolic protection filter in the right internal carotid artery via our right radial artery access site (Figure 2). Using the right radial artery, we passed a long run-through guidewire into the distal abdominal aorta. Due to severe aortic tortuosity, we were unable to snare the wire from the aorta. Therefore, we upsized the radial sheath to 7 French over both wires (runthrough and bare). Using a support catheter, we exchanged the runthrough wire for a Glidewire Advantage. We advanced an 8 x 29mm balloon expandable stent to the area of innominate stenosis and deployed it (Figure 3). We postdilated the stent with a 14mm balloon. Angiography demonstrated adequate expansion. On follow up, the patient was without claudication and had triphasic flow in the innominate and left subclavian arteries. Discussion: Treating innominate artery stenosis via radial access employing a sole entry point for both embolic protection and treatment administration offers a substitute where additional access is infeasible. Modern embolic protection techniques are superior due to their flexibility and ease of use. In this case, placing the embolic protection device in the carotid artery was mandatory through the sole radial access to prevent trapping the filter behind the innominate artery stent. We were able to perform both the embolic device placement and the stenting with the same radial access. Conclusion: Endovascular intervention of innominate artery stenosis via radial access, utilizing a single radial access for both embolic protection and treatment delivery, presents an alternative when femoral access is not feasible.

Redesign of work facilities at the tofu pressing station with a participatory ergonomic approach

Tahu Palda is a small and medium-sized micro business in the food industry that produces tofu. This factory has been producing tofu since 2005, located in North Aceh. The workers in this tofu usually five workers, with an average of 7 working hours per day. Based on the observations at several workstations, initial data indicate that the dominant work posture is standing, bending, and lifting heavy loads such as a 20 kg weight for pressing and lifting a mold holder with a 15 kg load. This is done continuously for 7 working hours each day. Based on the results of the distribution of the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), it was found that workers at the station experience complaints such as back pain, lower back pain, and upper arm pain due to the high frequency of lifting heavy loads. If this continues to be neglected, it can lead to work-related diseases such as musculoskeletal disorders. The assessment of workers' posture using the Rapid Entire Body Assessment (REBA) method shows that the score obtained for the job of pouring soybean paste is 7, which means a moderate risk, the job of lifting the press weight is 5, which means a moderate risk, and the job of flipping molds has a score of 10, which falls into the high-risk category and needs improvement. Improvements were made using a participatory ergonomics approach, resulting in the decision to redesign the tofu press tool to fit the workers' body anthropometry. The anthropometric calculations for the height range of the press support tool and cutting tool are 141.1 cm, the press support range is 68.78 cm, the width of the press tool is 49.4 cm, the height of the tray is 4.54 cm, and the height of the tray holder is 103.85 cm.

Clinical Efficacy and Complications of Spinal Surgery Unilateral Biportal Endoscopy for Cervical Spondylosis: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis evaluated the clinical efficacy and complications of unilateral biportal endoscopy (UBE) for treating cervical spondylosis (CS), providing evidence-based guidance for optimal treatment decisions. Relevant studies on UBE for CS were identified through comprehensive searches of PubMed, Embase, Web of Science, and the Cochrane Library up to April 22, 2024. Studies included patients diagnosed with CS who underwent UBE surgery and reported outcomes such as VAS scores, NDI scores, and postoperative complications. Data extraction and quality assessment were performed independently by two reviewers. Statistical analyses were conducted using Stata 15, employing random-effects models due to significant heterogeneity (I2 > 50%). Nine publications, comprising 353 patients and 400 operation levels, met the inclusion criteria. The mean follow-up duration was 17.01 months, and the operative time for a single level was 71.29 minutes. The average VAS score for neck pain decreased from 6.08 preoperatively to 1.52 postoperatively, the average VAS score for arm pain decreased from 7.13 to 1.35, and the average NDI decreased from 34.61 to 6.83 at the final follow-up. The mean satisfaction rate (good or excellent using the Macnab criteria) was 91%. The overall complication rate was 5%, with the most frequent complication being a dural tear (1%), followed by nerve root injury or transient hypoesthesia (0.3%). UBE demonstrates strong efficacy and safety in treating CS, with significant improvements in pain and disability scores, shorter operative times, and lower complication rates.

Post-procedural Brachial Neuritis: Clinical, Electrodiagnostic and Neuroimaging features.

Brachial neuritis is a monophasic condition affecting the brachial plexus and its branches, manifesting as acute shoulder and upper arm pain, followed by weakness and paresthesias. It can be triggered by antecedent events, including procedures such as surgery. Misdiagnosis and delay in diagnosis is common. Imaging is important to confirm the diagnosis of post-procedural brachial neuritis and exclude other etiologies. Clinical, electrodiagnostic, and neuroimaging features of patients with post-procedural brachial neuritis from a single quaternary care institution were identified and analyzed. Six (2 female) patients were identified with median age 62 (range 49-70) years. Antecedent procedures included 4 cervical spine surgeries, 1 rotator cuff repair, and 1 central venous catheter placement. Time to symptom onset ranged from 1-day to 2-weeks. The initial symptom for 5/6 patients was severe upper extremity pain followed by weakness. All patients had electrodiagnostic tests and MR neurography consistent with brachial neuritis. MR neurogram showed plexus and/or terminal branch abnormalities with associated muscular denervation edema. The C5 or C6 root, and/or upper trunk were always involved. The most common branches affected were the suprascapular, long thoracic, and axillary nerves. Hourglass constrictions of these nerves were seen in 3/6 patients. The average time to diagnosis was 3.4 (range 1.5-5) months. Post-procedural brachial neuritis is an underrecognized cause of acute upper extremity pain and weakness. MR neurography can exclude iatrogenic causes and document the presence of hourglass constrictions in affected nerves. Diagnostic neuroradiologists should be aware of this clinical entity and associated neuroimaging findings. HGC = hourglass constriction; EDX = electrodiagnostic; IRB = Institutional Review Board; ACDF = anterior cervical discectomy and fusion; NRS = Numerical Rating Scale; MUAP = motor unit action potential.

Factors Associated With Return to Work Following Laminoplasty for Degenerative Cervical Myelopathy.

Retrospective cohort study. To identify factors predictive of returning to work within 90 days of laminoplasty for degenerative cervical myelopathy (DCM). DCM is a debilitating condition resulting from spinal canal stenosis and spinal cord compression. One surgical option for cord decompression is cervical laminoplasty. Factors influencing return to work (RTW) postsurgery are unknown. This study included adult patients previously employed, undergoing primary elective laminoplasty for DCM, and with documented RTW status. Variables included demographic information, medical history, illness characteristics, and baseline patient-reported outcomes. The primary outcome of interest was RTW status at 90 days. Statistical analyses were conducted to identify predictors. Forty-six patients (67.6%) returned to work within 90 days, whereas 22 (32.3%) either RTW between 90 and 365 days (n = 3) or did not RTW within 365 days (n = 19). Significantly more patients who RTW within 90 days worked full-time (90.9% vs 64.3%, P = 0.030). Patients who RTW within 90 days had significantly lower preoperative Neck Disability Index scores (23.7 ± 17.5 vs 35.6 ± 14.3, P = 0.008) and higher preoperative modified Japanese Orthopedic Association scores (13.7 ± 2.5 vs 12.2 ± 2.7, P = 0.018) compared with those who did not RTW. No differences were found in other baseline patient-reported outcomes. Patients who RTW within 90 days had significantly lower postoperative 3-month neck pain (2.0 ± 2.1 vs 3.8 ± 2.6, P = 0.007), 3-month arm pain (1.3 ± 1.9 vs 3.6 ± 2.8, P < 0.001), 12-month neck pain (1.4 ± 1.6 vs 3.1 ± 2.4, P = 0.019) and 12-month arm pain (1.1 ± 1.8 vs 2.4 ± 2.4, P = 0.048) compared with those who did not RTW within 90 days. Higher preoperative modified Japanese Orthopedic Association scores were significantly associated with truncated time to RTW (HR: 1.14, 95% CI: 1.01-1.29, P = 0.034). Patients with better preoperative neck and arm pain and functional scores were more likely to RTW within 90 days postlaminoplasty. Preoperative functional status plays an important role in assessing RTW postlaminoplasty. This information is valuable for preoperative patient counseling.

The Effication of Low-Level Laser Therapy, Kinesio Taping, and Endermology on Post-Mastectomy Lymphedema: A Systematic Review and Meta-Analysis.

Post-mastectomy lymphedema is a common complication following breast cancer surgery, characterized by the accumulation of lymphatic fluid, causing swelling, discomfort, and functional limitations in the affected arm. Traditional treatments for lymphedema include manual lymphatic drainage and compression garments, but their effectiveness is variable, and many patients do not achieve satisfactory outcomes. Emerging therapeutic modalities such as Low-Level Laser Therapy (LLLT), Kinesio Taping, and Endermology offer potential non-invasive treatment alternatives. However, the relative efficacy of these approaches in reducing lymphedema, improving limb function, and enhancing quality of life in post-mastectomy patients remains unclear. This study aims to determine the effects of low-level laser therapy, kinesio taping, and endermology on breast cancer patients post-mastectomy with lymphedema. A systematic review and meta-analysis were conducted based on PRISMA guidelines. Searches were carried out in databases using keywords. Inclusion and exclusion criteria were applied to select the studies to be included. The selected studies were critically appraised using Cochrane's critical appraisal tool. The chosen studies were extracted and analysed both qualitatively and quantitatively. Quantitative analysis was performed using both fixed-effects and random-effects approaches. Eighteen studies were included in this analysis. All studies were randomized trials with good quality based on critical appraisal. The analysis found a significantly greater reduction in arm volume in the combined intervention group (MD = 76.27; 95% CI = 33.84-118.69) and in each therapy group: low-level laser therapy (MD = 91.98; 95% CI = 41.99-141.97) and endermology (MD = 34.61; 95% CI = 20.81-48.41). However, there were no significant differences in the reduction of arm circumference or pain scale, either overall or for each therapy individually. Low-level laser therapy and endermology provide better outcomes for breast cancer patients with post-mastectomy lymphedema compared to conventional therapy.

Relationship Between Pain, Muscle Strength, Function, and Quality of Life in Overhead Players With Chronic Internal Shoulder Impingement

Background and Objectives: This study aims to determine the relationship between pain, muscle strength, function, and quality of life (QoL) in overhead players with chronic shoulder internal impingement syndrome. Methods: Forty-seven overhead players consisting of 15 men, 32 and women (mean age 32.45±7.2) with chronic shoulder internal impingement were enrolled. The pain was measured by a visual analogue scale (VAS). Disabilities of the arm, shoulder, and hand (DASH) and shoulder pain and disability index (SPADI) questionnaires were used to measure pain and function, and a short form (SF)-36 questionnaire to measure QoL. Muscle strengths were evaluated in both hands with a hand-held dynamometer and players were asked to hold the maximal voluntary isometric contraction (MVIC) in the middle range for 3 s and rest for 30 s between each test and each contraction was repeated three times on both affected and healthy side and the average of contractions was considered for each side. Results: The study showed a significant relationship between pain, the strength of shoulder muscle groups (-0.354), function (-0.935), and QoL (-0.861) in overhead throwers with chronic shoulder internal impingement syndrome and the strength of internal rotators of the affected shoulder decreased more than others. (P&lt;0.05) Conclusions: This correlational study showed a significant relationship between pain and strength of shoulder muscles and function and QoL in overhead throwers with this syndrome.

Overloaded Vertebral Body Following Consecutive Three-Level Hybrid Surgery Comparing with Anterior Cervical Discectomy and Fusion.

Based on the varying number and relative positions of cervical disc replacement (CDR) and anterior cervical discectomy and fusion (ACDF) procedures, three-segment hybrid surgery (HS) presents a diverse structural approach. Currently, the potential differential effects of HS with different segment combinations and surgical procedures on overloaded vertebral body (OVB) occurrence remain unexplored. The purpose of this retrospective study is to compare the clinical and radiological outcomes of HS and ACDF in treating cervical degenerative disc disease (CDDD), aiming to provide further insights into OVB. This study included patients with three-level CDDD who underwent ACDF or HS at our institution. Eligible patients were divided into three groups: Type I (one-level CDR and two-level ACDF), Type II (two-level CDR and one-level ACDF), and ACDF (three-level ACDF). For radiographic analysis, patients were further divided into the Replacement Segment Group and the Nonreplacement Segment Group based on the presence of replacement segments above and below the OVB. Clinical outcomes were evaluated using visual analog scale (VAS) scores for neck and arm pain, Japanese Orthopedic Association (JOA) scores, and neck disability index (NDI) scores. The cervical radiological parameters assessed included (1) vertebral cross-sectional area (CSA), (2) wedge angle (WA), (3) anterior vertebral height (AH), (4) posterior vertebral height (PH), and (5) Hounsfield unit (HU) values. Statistical methods included paired t-test, ANOVA test, and chi-square test. Independent samples t-test, Mann-Whitney U test, and Wilcoxon signed-rank test were used to compare the differences between two groups according to the results of normal distribution test. A total of 123 patients, evenly distributed among three groups, were included and were well matched in terms of demographic characteristics. The likelihood of vertebral body collapse (VBC) was notably higher in the ACDF group (41.5%) compared with the Type I (17.9%) and Type II (8.9%) groups (p < 0.01). Following surgery, both at 3 and 6 months, the ACDF group demonstrated higher VAS neck scores and NDI scores compared with the Type I and Type II groups (p < 0.01). Additionally, the WA and AH values of the upper and lower adjacent OVB were consistently lower in the ACDF group than in the Type I and Type II groups at 6 and 12 months and at the final follow-up (p < 0.01). Notably, in the Nonreplacement Segment Group, WA significantly decreased at 12 months postoperatively and at the final follow-up compared with the Replacement Segment Group (p < 0.01). Three levels of HS appear to reduce stress concentrations and alleviate morphological changes in OVB. The occurrence of more VBC patients with OVB was associated with the use of Zero-P or Zero-P VA implants.