Limitation Of Shoulder Motion Research Articles

Comparison of clinical and functional outcomes of physical therapy alone versus additional intraarticular injection of platelet rich plasma in treatment of frozen shoulder in Indian population

Background: Frozen shoulder (adhesive capsulitis) involves significant restriction of shoulder motion due to an inflammatory process and typically follows stages of pain, stiffness, and recovery over 2-3 years. This study explores the efficacy of platelet-rich plasma (PRP) injections, alongside conventional physiotherapy, as a non-operative treatment to enhance recovery in patients with adhesive capsulitis. Methods: This prospective, randomized, open, blinded, single-center clinical study involving 50 patients with adhesive capsulitis, comparing intra-articular PRP injections and physical therapy with physical therapy alone over 24 weeks. Primary outcomes were assessed using the shoulder pain and disability index (SPADI) and visual analog scale (VAS), with follow-ups at 6, 12, and 24 weeks to evaluate pain, function, and patient satisfaction. Results: In adhesive capsulitis (AC), intra-articular platelet-rich plasma (IA-PRP) injections with physical therapy (PT) provided superior pain relief, functional improvement, and higher treatment satisfaction after 24 weeks compared to PT alone. The IA-PRP group also showed better VAS scores and reduced acetaminophen use, indicating more effective pain management. Conclusions: In AC, IA-PRP injections showed greater pain relief and improved shoulder mobility compared to PT alone after 12 weeks. PRP's effectiveness highlights its potential, especially when corticosteroids are unsuitable, though longer-term studies are needed to confirm these results.

Psychometric properties of the Disability of Arm Shoulder and Hand (DASH) in subjects with frozen shoulder: a reliability and validity study

BackgroundFrozen Shoulder (FS) is a painful condition characterized by severe pain and progressive restriction of shoulder movement, leading to functional impairment and reduced quality of life. While different Patient Reported Outcome Measurements (PROMs) tools exist for assessing shoulder diseases, few specific PROMs are validated for FS patients.PurposeThis study aims to assess the psychometric properties of the Disability of Arm, Shoulder, and Hand (DASH) questionnaire in FS patients.MethodsOne hundred and twenty-four subjects (mean ± SD age = 55.4 ± 7.9 years; 55.6% female) diagnosed with FS were included and completed the DASH questionnaire, the Numerical Pain Rating Scale (NPRS), the Shoulder Pain and Disability Index (SPADI), and the Short-Form Health Survey 36 (SF-36). Floor or ceiling effects were investigated. Structural validity was analysed through a unidimensional Confirmatory Factor Analysis (CFA), internal consistency through Cronbach’s alpha, test-retest reliability through the Intraclass Correlation coefficient (ICC), measurement error through the Standard Error of Measurement (SEM), and the Minimum Detectable Change (MDC), and construct validity through the hypothesis testing with the correlation with the other outcome measures used.ResultsNo floor or ceiling effects were observed. CFA confirmed a one-factor structure after addressing local item dependency (Root Mean Square Error of Approximation = 0.055; Standardized Root Mean Square Residual = 0.077; Comparative Fit Index = 0.970; Tucker-Lewis Index = 0.968). Cronbach’s alpha was high (= 0.951), and test-retest reliability was excellent (ICC = 0.999; 95% CI: 0.998-1.000). SEM was equal to 0.5 points, and MDC to 1.5 points. Construct validity was considered satisfactory as 80% of the a-priori hypotheses were met.ConclusionThe DASH questionnaire demonstrated good psychometric properties in FS patients, supporting its use as a valuable tool for assessing the impact of FS in clinical and research settings.

Sternoclavicular joint tuberculosis

Abstract We studied five patients who presented with complaints of swelling of the sternoclavicular joint (SCJ), with pain and restriction of shoulder movements in some. There was no clinical or imaging evidence of pulmonary involvement in any of these patients. The diagnosis of SCJ tuberculosis (TB) was ascertained by histopathological evidence (n = 2), by Xpert MTB/RIF (n = 1) and based on clinical presentation and response to anti-TB treatment (n = 2). On follow-up, all patients had responded well to anti-TB treatment. TB should be considered in the differential diagnosis in patients presenting with subacute/chronic SCJ arthritis, with or without pulmonary involvement, especially in high TB burden countries.

Prevalence and Correlation between MRI Findings and Outcome of Conservative Treatment in Primary Idiopathic Frozen Shoulder.

Primary idiopathic frozen shoulder (FS) causes pain and stiffness in the shoulder joint. Over time, this disease causes restriction of shoulder motion. We undertook this study to evaluate possible correlation of MRI findings with outcome of conservative management in FS. A total of 65 cases participated in prospective cohort study. The correlation of MRI findings obtained before commencing the treatment with outcome of non-operative management (Mean of ROM, VAS, SST and OSS) was evaluated. Anterior extracapsular edema significantly correlated with FF, EXR, VAS (a) and OSS. The effusion in humeral side of axillary recess significantly correlated with ROM restriction in ABD, EXR. Capsular thickness of glenoid portion showed good significance with FF, ABD, VAS (a) and OSS. Increased thickness of CHL showed negative correlation with improvement of EXR (P=0.049) (r=-0.617). Thickening of IGHL showed negative correlation with improvement of ABD (p=0.005 r=-0.862) and FF (p=0.007 r=-0.831). Mean Height of Axillary recess (HAR) was 7.2mm (3.5-11mm). HAR showed negative correlation with VAS pain scale (P=0.036) (r=-0.682) and OSS (P=0.038) (r=-0.668). Thickness of the joint capsule and effusion at the axillary fold are important factors for refractory frozen shoulder. We can recommend MRI for refractive cases and low threshold of expectation can be set for conservative management in patients with above findings.

Efficacy of rotator cuff suture and arthroscopic 360° capsular release in patients with rotator cuff tear with limited shoulder movement

BackgroundTo determine the clinical efficacy of rotator cuff suture and arthroscopic 360° capsular release in patients with rotator cuff tendinopathy to improve the Constant-Murley and Visual Analogue Scale (VAS) scores, and shoulder flexion.MethodsFifty-one patients with full-thickness rotator cuff tears and limited shoulder movement who were admitted to our hospital from October 2017 to October 2020 were selected; all patients were treated with arthroscopic rotator cuff suture and 360° capsular release. The Constant-Murley score, VAS score, and shoulder flexion angle were used to evaluate shoulder joint function before and during follow-up. Rotator cuff healing was assessed by MRI with the Sugaya classification.ResultsAfter treatment, the Constant-Murley score (58.98 ± 9.84) was significantly improved compared with pre-treatment (29.33 ± 9.71), the VAS score (1.23 ± 0.87) was significantly lower than pre-treatment (7.54 ± 1.22), and the shoulder flexion angle (142.67 ± 8.59°) was significantly improved compared with pre-treatment (51.50 ± 2.10°); the difference was statistically significant (P < 0.05).ConclusionsArthroscopic rotator cuff suture and simultaneous 360° capsular release have a significant effect on the treatment of rotator cuff tear with limited shoulder movement.

Clinical Efficacy, Safety, and Complications of the Arthroscopic Cartilage Shaving Procedure for Secondary Osmidrosis Treatment

Background Axillary osmidrosis is a common disease with negative psychosocial impact on patients. Further, many treatment modalities are not sufficient and result in recurrence. Objective We aimed to evaluate the effectiveness and safety of using a cartilage shaver in patients with recurrent osmidrosis to remove tightly attached apocrine glands and subdermal scars. Methods We retrospectively evaluated 24 patients with secondary axillary osmidrosis who underwent cartilage shaving surgery between January 2013 and May 2022. We analyzed the incidence of complications, including seroma, infection, pigmentation, wound dehiscence, skin necrosis, scarring, shoulder movement limitation, comedones/sebaceous cysts, and nerve injury. Clinical effectiveness was also evaluated. Results Excellent or good efficacy with improved malodor was achieved in 24 patients (47 axillae [100%]). Complications were observed in 16 (36.17%) axillae, including hematomas (n = 2), pigmentation (n = 7), skin necrosis (n = 3), and comedones/sebaceous cysts (n = 4); one patient (2.13%) required local debridement. Mean Vancouver Scar Scale scores were markedly low (5.41 to 4.67). Scar tissue did not interfere with the shaving surgery, allowing for successful removal of the apocrine glands. Conclusions Secondary osmidrosis treatment using a cartilage shaver system yielded satisfactory and better scar results than the patients' previous treatments.

Does the dominant hand’s use affect the complication rates in prosthetic breast reconstruction?

Background Numerous studies have investigated risk factors for unfavorable outcomes in prosthetic breast reconstruction, such as obesity, perioperative radiotherapy, and acellular dermal matrix use. However, no reports have explored whether the use of the dominant hand influences complications in breast reconstruction. To address this gap in the literature, analyzed complication rates between the dominant and non-dominant sides after reconstruction.Methods We retrospectively reviewed the charts of 160 patients (170 breasts) who underwent breast reconstruction from February 2017 to March 2022. We analyzed the complications between beasts on the dominant and non-dominant sides according to the reconstruction method.Results During prosthetic breast reconstruction, the drainage volume and duration on the dominant side exceeded those on the non-dominant side after reconstruction (duration: 9.79 days on the dominant side vs. 9.12 days on the non-dominant side, P=0.196; volume: 771.1 mL on the dominant side vs. 654.3 mL on the non-dominant side, P=0.027). The incidence of complications such as wound dehiscence, mastectomy flap necrosis, and infection was significantly higher in the dominant hand group (infection: 6 vs. 0, P=0.014; dehiscence: 15 vs. 4, P=0.009; flap necrosis: 13 vs. 4, P=0.024).Conclusions Complications including seroma, infection, and mastectomy skin flap necrosis following prosthetic reconstruction were common in breasts on the dominant-hand side. Therefore, meticulous management and restriction of shoulder movement can aid in preventing seroma-related complications in prosthetic breast reconstruction, especially on the side of the dominant hand.

Treatment of coracoid process fractures combined with acromioclavicular joint dislocation using clavicular hook plate.

The injury mechanism of acromioclavicular (AC) dislocation combined with coracoid process (CP) fracture is not clear, and there is no consensus on its treatment. This study was performed to evaluate the diagnosis of CP fractures combined with AC dislocation and the effectiveness of operative treatment using a clavicular hook plate. Eighteen patients with CP fractures combined with AC dislocation were treated with a clavicular hook plate from May 2012 to June 2021. The patients comprised 10 male and 8 female patients with an average age of 38years (range, 16-54years). The injury was caused by falling in 15 patients, traffic accidents in 2 patients, and falling from a height in 1 patient. The Eyres type of CP fracture was type II in 1 patient, type III in 11 patients, type IV in 3 patients, and type V in 3 patients. The Ogawa type of CP fracture was type I in 17 patients and type II in 1 patient. The Rockwood type of AC dislocation was type V in 1 patient, variation type III in 15 patients, and variation type V in 2 patients. The interval from injury to the operation was 3days (range, 1-7days). Postoperative complications and CP fracture healing were recorded. Functional assessment at the last follow-up was performed by an independent reviewer using the Constant score and visual analog scale score. All 18 patients were followed up for a mean period of 49months (range, 12-123months). Nine patients had acromion osteolysis and 3 patients had CP fracture nonunion (Eyres type II, III, and V in 1 patient each); however, no patients developed shoulder pain, incision infection, limitation of shoulder movement, clinical symptoms of subcoracoid impingement, or AC dislocation relapse. At the last follow-up, the mean Constant score was 99 (range, 94-100). The possibility of CP fracture should be considered in patients with AC dislocation to avoid a missed diagnosis. Fixation with a clavicular hook plate is a feasible treatment for CP fracture combined with AC dislocation and provides a satisfactory outcome. CP fracture healing may be related to the fracture morphology.

Clinical significance of the elbow forward translation motion in patients with rotator cuff tears

Range of motion (ROM) limitations can result in restricted activities of daily living (ADL) due to shoulder dysfunction, suggesting that evaluation of complex shoulder movements is necessary in clinical practice. Here, we present a new physical examination, the elbow forward translation motion (T-motion) test for measuring the position of the elbow when both dorsal hands are placed on the iliac crest in a sitting position and the elbow is moving forward. We examined the relationships between T-motion and shoulder function to identify the significance of this test in clinical practice. Preoperative patients with rotator cuff tears (RCTs) were eligible for this cross-sectional study. Active ROM and Japanese Orthopaedic Association (JOA) scores were measured as shoulder function. The degree of internal rotation was based on the Constant-Murley Score. We defined a positive T-motion test result as an elbow positioned posterior to the body on the sagittal plane. Group comparisons and logistic regression analyses were conducted to investigate the relationships between the availability of T-motion and shoulder function. Sixty-six patients with RCTs participated in this cross-sectional study. The values of the JOA total score (P<.001), subscale of function and ADL (P<.001), active range of forward flexion (P=.006), abduction (P<.001), and external rotation (P<.001) were lower in the positive group than in the negative group. In addition, a significant correlation was found between the availability of T-motion and internal rotation by the chi-square test (P<.001). Logistic regression analyses showed that internal rotation (odds ratio 2.69; 95% confidence interval 1.47-4.93; P<.01) and external rotation (odds ratio 1.07; 95% confidence interval 1.00-1.14; P=.04) were related to the availability of T-motion after adjustments for covariates, and the cutoff points were 4 points for internal rotation (area under the curve 0.833, sensitivity 53.3%, specificity 86.1%, P<.001) and 35° for external rotation (area under the curve 0.788, sensitivity 60.0%, specificity 88.9%, P<.001). The positive T-motion group exhibited low shoulder function, including a less active ROM and JOA shoulder score. T-motion, which is a quick and simple movement, may be a new indicator for a complex shoulder motion and contribute to evaluating the decreased ADL and limited shoulder motion in patients with RCTs.

Cytokines' Role in the Pathogenesis and Their Targeting for the Prevention of Frozen Shoulder: A Narrative Review.

Frozen shoulder (FS) is a common name for shoulder movement limitation with different degrees of shoulder rigidity and pain. It is characterized by varying developmental courses, different levels of shoulder movement limitation, and background ambiguity due to the multiplicity of its causative factors. Systemic inflammatory cytokines monitoring and restraining is easy to apply, fast to conduct, and needs lower costs compared to invasive methods for frozen shoulder stageevaluation and early controllingof its progress to the stage that necessitates surgical intervention. The aim of this review was to assess the recent findings concerning the role of cytokines in FS pathogenesis and the possibility of preventing or controlling their progress through targeting these cytokines by the newdrugs candidates, such as hyaluronan (HA), botulinum toxin type A (BoNT A), Tetrandrine, tumor necrosis factor-stimulated gene-6 (TSG-6), and cannabidiol. Searching the PubMed site, we encountered out of 1608 records, from which16 originalstudies were included for the quantitative construction of this systematic review screening of the recent studies to investigate the different FS pathogenic pathways. Most of the scenarios arecentered around the inflammatory and fibrotic process triggered by synovial and capsular fibroblast stimulation. This mechanism depends mainly on alarmins cytokines, including thymic stromal lymphopoietin (TSLP), interleukin-33 (IL-33), and interleukin-25 (IL-25),with the stimulation of interleukin-1 α (IL-1α), interleukin-1 β (IL-1β), tumor necrosis alpha (TNF-α), cyclooxygenase-1 (COX-1) andcyclooxygenase-2 (COX-2) in a joint capsule. Different pathways of transforming growth factor- β (TGF-β) stimulation, resulting in overexpression of the fibrotic factors as tenascin C (TNC), fibronectin 1, collagen I (COL 1)and collagen III (COL III), and matrix metalloproteinases (MMPs) in thecapsular or synovial/capsular fibroblasts. The overall investigation of these studies led us to conclude that the newdrugcandidates proved their efficiency in controlling thecommon pathogenesis of the inflammatory and fibrotic pathways of frozen shoulder and therefore represent a prospect for easy and early controlling and efficiently treating this serious disease.

Prospective study comparing between plate osteosynthesis and antegrade interlocking nailing its functional and radiological outcome in treating humeral shaft fractures

Humeral shaft fractures are common injuries making upto 1-3% of all fractures. They are widely treated by conservative methods leading to higher rates of non-union. Henceforth surgeons tend to perform operative procedures to treat them. To statistically analyse and compare the functional and radiological outcome of two treatment modalities of humeral shaft fractures, they are plate osteosyntheis and antegrade intramedullary nailing. A total of 22 patients of humeral shaft fractures were operated by either of two methods 12 in plating (P) group ,10 in nailing (N) group and their radiological outcome was assessed by rate of union, time taken for callus formation etc and their Functional outcome was analysed based on Rodriguez Merchan criteria. The commonest age group of patients operated is 21-40 years (70%) majority being males (70%) and road traffic accident being commonest mode of injury. The plate osteosynthesis group stands superior than nailing group in terms of duration of union (20 weeks), rate, percentage of union (100%), least risk of non-union (0). Statistically significant (p&lt;0.05) improvement in shoulder joint function with minimal complications. The plate osteosynthesis method is the most promising surgical procedure for treating humeral shaft fracture due to negligible rates of non-union and early recovery of motion. Though nailing group has minimal need of soft tissue dissection, preserves fracture biology, decreased operative time and early rehabilitation period it still stands inferior when it comes to complications like rotator cuff injury, shoulder impingement pain and restriction of shoulder movements. Ultimately the post operative quality of life is equally good in both techniques.

ОРГАНИЗАЦИОННЫЕ И ТЕХНОЛОГИЧЕСКИЕ ОСОБЕННОСТИ ПРИ ЛЕЧЕНИИ ПАЦИЕНТОВ С ВЫВИХОМ ПЛЕЧА (ОБЗОР ЛИТЕРАТУРЫ)

Introduction. Shoulder dislocation currently continues to be the most common among dislocations of all localizations - about 45%. Over the years of observation, this indicator has been decreasing in different countries. More than 50 methods of correcting shoulder dislocation have been described. Methods of correction and organizational features of the treatment of injured are the subject of discussions on scientific forums and on the pages of specialized magazines. The review is dedicated to the analysis of organizational and technological features shoulder dislocation. Results. The existing methods of correcting shoulder dislocation can be divided into three groups: lever; physiological methods based on muscle stretching (traction); methods involving pushing the head of the humerus into the joint cavity (push methods). Despite the many ways, the recurrence shoulder dislocation is noted in almost every second victim. Most often, relapse is stated by young patients. Many specialists note the shortcomings of the methods of correcting the primary traumatic shoulder dislocation as in terms of the choice of the method of correction, and in terms of the organization of the therapeutic and diagnostic process. Among the complications of shoulder dislocation reduction, instability of the shoulder joint, habitual dislocation, restriction of shoulder movement are most often verified. The review analyzes the main methods of conservative correction of shoulder dislocation, provides data on the frequency and structure of complications. Separately, information about anesthesia for the reduction of shoulder dislocation is noted. The features of treatment of injured with shoulder dislocation in outpatient conditions and during hospitalization are shown. Presented overview the literature allows you to orientate yourself in the state of the issue of conservative correction of shoulder dislocation today.

Effect of Gleno-humeral-capsulo-Ligamentous Stretch Maneuvers on Range of motion in Bilateral Frozen Shoulder

Background: Painful restriction of shoulder movement, without an underlying cause, which results in complete loss of motion of the glenohumeral joint is called Frozen Shoulder. The process is started with an inflammation of the lining of the joint within the shoulder. Gradually this area thickens and results in the shoulder becoming stiffer and more painful. It is seen commonly at the age of 40-65 years and more often in women. Overall, this condition affects work, leisure, and quality of life. Frozen shoulder often progresses in three stages: the freezing, frozen and thawing phases. Risk factors for frozen shoulder are diabetes, thyroid, history of shoulder trauma, cervical radiculopathy, post-operative immobilization, and shoulder surgery. Cyriax described the typical capsular patterns of the gle¬no humeral joint in the frozen shoulder with abduction more limited than external rotation, and external rota¬tion more limited than internalrotation. This study aims to establish the effect of gleno humeral capsulo ligamentous stretch maneuvers on bilateral frozen shoulder. Methods: A total of 40 subjects diagnosed with bilateral frozen shoulder were selected for the study. Subjects received low load prolonged stretching, mobilization and shoulder range of motion exercises. Each session was conducted for 30 minutes duration, 5 days per week for 4 weeks. Outcome measures used were Numerical pain rating scale (NPRS), Goniometer and Shoulder Pain and Disability Index (SPADI). Results: The results of the study demonstrate that there was a significant effect of gleno humeral capsulo ligamentous stretch on numerical pain rating scale (p&lt;0.0001), range of motion (Shoulder flexion, abduction, internal rotation and external rotation (p&lt;0.0001), Shoulder pain and disability index (p&lt;0.0001) during the pre and post intervention assessment. Conclusion: It is concluded that that the use of low load prolonged stretch and mobilization was very effective in reducing pain and improving range of motion. Shoulder range of motion exercises was effective in improving strength and flexibility of shoulder musculature. KEYWORDS: Low load prolonged stretch, mobilization, numerical pain rating scale, Shoulder pain and disability index, Bilateral frozen shoulder.

Association of Depression and Anxiety with Shoulder Pain and Disability Index in Adhesive Capsulitis

Background: Impingement syndrome is a disorder of unknown etiology in which the restriction of shoulder movements is the result of inflammation of shoulder joint capsule and its ligaments. Aim: To explore relationship of depression and anxiety among Patients of Adhesive Capsulitis, and correlation of despair and nervousness with shoulder pain and disability index in Adhesive Capsulitis. Methodology: A correlational study was conducted in which 280 patients of both genders from different Hospitals were taken. A Questionnaire examined the association of depression and anxiety and determine the rate of Shoulder pain and Disability index in Frozen Shoulder patients. The Shoulder pain and Disability index scale and Hospital Anxiety and Depression Scale were also included in this study. SPSS v.26 analyzed the data. Mean±SD presented quantitative variables. Results: Out of 280 classified as diagnosed patients of Adhesive capsulitis in correlational study with mean and standard deviation of age is 49.75±8.19, Among 280, 33.9% were males and 66.1% were females. This study enumerates correlation between SPADI and HADS-A and between SPADI and HADS-D and the correlation is significant at the 0.01 level(2-tailed). Of the 280 FS patients, 62.5% had a high risk of anxiety and 37.5% were without anxiety. Conclusion: It was concluded in our study that there is strong association of depression and anxiety with Shoulder pain and Disability index in Adhesive Capsulitis. Keywords: Frozen Shoulder, SPADI, HADS and Depression.

Prevalence of Positive Level IIb Lymph Nodes in Tongue Carcinoma: Experience From a Tertiary Care Center in North India.

IntroductionComplications during and after dissection of level IIb lymph nodes include spinal accessory nerve (SAN) dysfunction, which results in the limitation of shoulder movements and, thus, hurts the quality of life. The current study aims to know the occurrence of level IIb lymph node positivity in tongue carcinoma.MethodsThis cross-sectional study was conducted from January 2019 to December 2019 in a tertiary care center in North India. Adult cases with primary ulcer-proliferative growth over the lateral border of the tongue were included in the study. The level IIb lymph node positivity from the postoperative histopathology report was the primary outcome measure of this study. To investigate the potential association of tumor size on level IIb lymph node positivity, we compared the maximum tumor dimensions among the level IIb lymph node-positive and -negative groups. In addition, to analyze the impact of the tumor's invasive nature on level IIb lymph node positivity, we compared the depth of invasion and proportion of cases with muscle involvement among the level IIb lymph node-positive and -negative groups. Lastly, to investigate their concurrent occurrences, we compared the number of level IIb lymph node-positive cases among the level IIa lymph node-positive and -negative groups.ResultsA total of 39 patients fulfilling the inclusion criteria were included in the study. Only six had positive level-IIb lymph nodes. No significant associations of tumor size, invasion depth, muscle invasion, or involvement of level IIa lymph nodes with the positivity of level IIb lymph nodes were found. However, only three were level IIb lymph node-positive in 28 level IIa lymph node-negative cases.ConclusionConsidering the low risk of isolated level IIb lymph node positivity in level IIa lymph node-negative cases, the dissection of level IIb nodes could be omitted during the surgical excision of the tumor. However, radiological investigations detecting metabolic activity should be used in the preoperative period and postoperative follow-up to detect early lymph node involvement and disease recurrence.

A rare case of caries sicca right shoulder

Caries sicca is the classic dry form of tuberculosis of proximal humerus. Caries sicca is a fairly rare extrapulmonary presentation of bone tuberculosis. It accounts for 0.9 to 1.7 percent of all extrapulmonary tuberculosis cases. A 23-year-old female presented to the orthopaedics outpatient department with complaint of pain and restriction of shoulder movements for 6 months. The patient has no history of tuberculosis previously, but has a history of a family member suffering from pulmonary Koch. On clinical examination there was tenderness over the Greater tuberosity with restricted external rotation, abduction up to 30 degrees with further passive abduction being painful. There was marked wasting of deltoid and other muscles. Patient´s biopsy was taken for histopathology which showed normal morphology of bony trabeculae, fibromuscular and fatty tissue infiltration of chronic inflammatory cells and at places epithelioid granuloma with langhans giant cells and caseous necrosis which favor the diagnosis of tuberculosis. The patient was started on chemotherapy antitubercular drugs with intensive phase of 2 months and continuation phase of 7 months. During the treatment period the patients were followed up clinic radiologically and the satisfactory shoulder movements abduction up to 90 degrees achieved after 9 months and erythrocyte sedimentation rate (ESR) was considered as a prognostic factor for treatment.

The Dorsal Scapular Artery Perforator Flap: A Complete Muscle-sparing Technique.

Summary:Cervical and thoracic spine reconstruction can be a difficult area to provide stable soft tissue coverage. Historically, trapezius myocutaneous flaps and trapezius muscle turnover flaps have proven to be reliable and versatile methods for the reconstruction of these areas. However, sequelae such as restriction of shoulder movement have been reported, as well as unsightly “humpback” contour deformities from turnover flap bulk. The use of the trapezius muscle for coverage has evolved to include descriptions of a trapezius perforator flap to address some of the issues of donor site morbidity, as it is described as a muscle-sparing technique. Although described as “muscle-sparing,” these approaches nonetheless involve sacrifice of trapezius muscle overlying the pedicle as that musculature is “deroofed” and divided off the pedicle during dissection. In this article, we present a detailed technical description of our novel technique to the trapezius perforator flap using a dorsal scapular artery flap for spinal reconstruction that is truly, completely muscle-sparing. This technique may prove useful for those patients in which even minimal disruption of trapezius muscle fibers is undesirable.

A study of second to fourth digit ratio in relation to verbal and numerical intelligence among medical students

Introduction and Aim:Periarthritis shoulder is generally defined as a self - limiting disorder that affects mostly the diabetic persons. Periarthritis shoulder affects the older population with females at its peak.This study was intended to find out whether all the shoulder pain subjects were victims of periarthritis shoulder and to analyse the prevalence of periarthritis among subjects who were suffering from shoulder.&#x0D; &#x0D; Materials and Methods:This study was a prospective, observational study conducted on the patients who visited the outpatient Physiotherapy Departments. Nearly 300 patients who came with shoulder pain were taken as samples. A detailed explanation about the purpose of the study was given to the subjects. The subjects included were based on the inclusion criteria pain more than 1 month, both male and female, age group of 40-60 years, both dominant and non-dominant hand, history of shoulder pain at night, progressive limitation of shoulder movement, particularly a reduction of at least half the normal range of abduction and external rotation.&#x0D; &#x0D; Results:Based on the inclusion and exclusion criteria nearly 300 participants were selected and they were asked to fill the SPADI questionnaire. Out of 300 participants nearly 127 subjects were concluded with positive signs of periarthritis shoulder.&#x0D; &#x0D; Conclusion: The result obtained from our study states that the severity of the disease is more among the female population. The subjects who are suffering from shoulder pain must be taken into anticipation that in future they may develop shoulder periarthritis.

EFFECTS OF A DEEP LEARNING-BASED SMARTPHONE APPLICATION ON SHOULDER ABDUCTION KINEMATICS AND BRAIN ACTIVATION IN ADHESIVE CAPSULITIS: A RANDOMIZED CONTROLLED TRIAL

Patients with adhesive capsulitis (AC) demonstrate limited shoulder movement, often accompanied by pain. Common treatment methods include pain medication, and continuous passive movement (CPM). However, it is sometimes difficult to improve the reduction of pain and movement using a CPM intervention because the patient’s interest is diminished. In this study, we developed an innovative deep learning-based smartphone application (Funrehab exercise game (FEG)) to provide accurate kinematics movement and motivation as well as high-intensity and repetitive movements using deep learning. We compared the effects of CPM and FEG on brain activity and shoulder range of motion in patients with AC. Sixteen patients (males, [Formula: see text]; females, [Formula: see text]; mean age, [Formula: see text] years) with acute AC were randomized into either CPM group or FEG group 4 days/week for 2 weeks. The outcome measures were shoulder abduction kinematics movement and electroencephalography (EEG) brain activity (bilateral prefrontal, bilateral sensorimotor cortex, and somatosensory association cortex) during the intervention. The analysis of variance (ANOVA) test was performed at [Formula: see text], and the analysis demonstrated that FEG showed superior effects on shoulder abduction kinematics and brain [Formula: see text] and [Formula: see text]-wave activations compared to CPM. Our results provide a novel and promising clinical evidence that FEG can more effectively improve neurophysiological EEG data and shoulder abduction movements than CPM in patients with AC.

A Proposed Method to Quantify the Effect of Head and Shoulder Position on Kyphotic Deforming Forces before and after Spine Surgery

While sagittal balance of the spine is examined regularly before and after surgery for kyphotic spinal deformity, current radiographic measurement techniques limit assessment of sagittal balance to the spine and pelvis (or femoral heads) only and ignore the head and shoulder position. Patients with kyphotic deformity often have anterior positioning of the head, along with protracted shoulders with limited shoulder motion and weak back muscles.