Shoulder Dysfunction Research Articles

Advancement in Arthroscopic Superior Capsular Reconstruction for Irreparable Massive Rotator Cuff Tear.

Irreparable massive rotator cuff tear (IMRCT) was one of the causes of shoulder dysfunction, despite technical improvement, the failure rate of IMRCT was still demonstrated to be high. Traditional treatments like non‐surgical treatments, partial rotator cuff repair, and tendon transfers could only achieve a slight improvement. A potential cause for high failure rate was the fact that traditional treatments cannot restore the superior stability of glenohumeral joint, and thus restricted the movement of shoulder joint severely. Superior capsular reconstruction (SCR) using a variety of grafts (autograft, allograft, xenograft, or synthetic grafts) provided a promising option for IMRCT. In surgery, graft was fixed medially to superior glenoid and laterally to the footprint of humeral greater tuberosity. SCR could increase the stability of the superior glenohumeral joint, decrease the subacromial pressure and acromiohumeral distance. This review summarized the relevant literature regarding the alternative grafts, surgery indications, operative techniques and clinical outcomes of SCR. we compared the different grafts, key surgical steps, the advantages and disadvantages of different surgical methods to provide clinicians with new surgical insights into the treatments of IMRCT. In conclusion, IMRCT without severe glenohumeral arthritis was the best suitable indication for SCR. The clinical outcomes were positive in the short‐term and middle‐term following‐up. More studies were necessary to determine long‐term results of this surgical procedure.

Sprengel Deformity with Cervical Myelopathy a Rare Entity: A Case Report

Sprengel's Deformity is a congenital condition characterized by a small and undescended scapula often associated with scapular winging and scapular hypoplasia. Diagnosis is made clinically with a high-riding, medially rotated, triangular-shaped scapula, with associated limitations in shoulder abduction and flexion. Treatment is observation in the absence of shoulder dysfunction. Operative management is indicated in the presence of severe cosmetic concerns or functional deformities (abduction < 110-120 degrees). We herewith present a case of this deformity seen in our center in patient of cervical stenosis with myelopathy.

Evaluation of shoulder function after repairing head and neck defects with supraclavicular flap

Objective: To evaluate the shoulder function in patients after repair of head and neck defects with supraclavicular flap. Methods: A retrospective analysis was performed on 56 patients (54 males, 2 females, aged 35-74 years old) who received the repair of head and neck defects with supraclavicular flaps at Department of Otorhinolaryngology Head and Neck Surgery of Beijing Tongren Hospital, Capital Medical University in January 2013-December 2020. The areas and types of flaps, disruption or infections of the incision at the donor sites and other postoperative complications were recorded. Quick disabilities of the arm, shoulder and hand (Quick-DASH) was used for evaluating the shoulder functions in 43 patients conforming to the standard for evaluation of the clinical functions of shoulders and upper limbs, to compare the postoperative upper limb functions between patients treated with clavicular flaps and patients with acromion flaps. Meanwhile, 30 patients who received bilateral neck lymph node dissection over the same period of time were selected for a comparative evaluation of the donor sides (observation group) and the opposite sides (control group). Data were processed with SPSS 22.0. Results: The areas of obtained supraclavicular flaps were (4-10) cm × (10-18) cm. Three patients (5%) showed the defect widths of 8-10 cm at the donor sites, which couldn't be sutured directly, received the repair of their shoulder defects with partial flaps. Defects in other patients were sutured directly. After surgery, 3 patients (5%) suffered from disruption of the acromion incision, which healed after 2 weeks of local dressing. The follow-up time was 6-43 (27±14) months. All patients expressed no dissatisfaction with the appearance. Among 43 patients, 28 (65%) were clavicular type and 15 (35%) were acromion type. The acromion type showed average motor ability and Quick-DASH scores higher than the clavicular type [(average motor ability: (14.4±4.7) vs. (11.8±3.1), t=2.105, P=0.048; Quick-DASH: (16.9±11.6) vs. (12.2±7.1), t=2.284, P=0.033]. Among 30 patients who received bilateral neck lymph node dissection over the same period of time, the observation group showed higher average motor ability, local symptoms and Quick-DASH scores than the control group [average motor ability: (13.4±5.8) vs. (9.8±4.2), t=3.024, P=0.004; average local symptoms: (4.1±1.0) vs. (3.4±1.0), t=2.537, P=0.014; Quick-DASH: (15.6±14.7) vs. (5.2±11.1), t=3.106, P=0.003]. Conclusion: Shoulder dysfunction exists after treatment with supraclavicular flap, which is related to the flap type.

Comprehensive rehabilitation of Supraspinatus tear: A case study of post-op fracture stiffness

The disorders of the upper extremity and the shoulder is extremely common accounting for 30 % of people who experience shoulder pain and stiffness at some stage of their ageing. A high incidence of shoulder dysfunction is seen in people in recent trends. Shoulder stiffness is the main complication after fracture shoulder immobilization, and Diabetes Mellitus contribute to the frozen shoulder, which is the most typical complication in Diabetes mellitus patients. A case of lateral clavicle fracture with chief complaints of pain on the right shoulder, stiffness around the joint and reduced range of motion was reported to the outpatient physiotherapy department for rehabilitation. A proper assessment was done, and the differential diagnosis was frozen shoulder with supraspinatus tendon tear was reported. The patient also had a reduced range of motion of shoulder abduction and lateral rotation due to frozen shoulder. The investigation of MRI report stated that there is a partial supraspinatus tendon tear. Medical examination of the frozen shoulder confirms the diagnosis. A combination of non-pharmacological treatment with exercises, NSAID and exercise therapy, was planned. He was successfully treated with the combination of physical therapy treatment with the electrotherapy modalities and shoulder girdle mobilization. Comprehensive therapeutic exercises include mobilization of soft tissue using Cyriax technique, peripheral joint mobilization to improve controlled ROM. Mobilization of soft tissue along with home exercise supports patients suffering from frozen shoulder. The treatment primarily aimed at relieving pain and increasing range of motion and thus improving the quality of life in the patient. Only manual therapy alone does not give satisfactory results along with electrotherapeutic modality with proper dose work on the patient.

Arthroscopic Reverse Bankart Surgical Repair

Background: Posterior glenoid labrum lesions occur in only 2% to 10% of all cases of shoulder instability, yet these injuries may cause significant shoulder dysfunction in an athletic population. Moreover, these injuries frequently require surgical intervention and present a unique surgical challenge. Indications: Indications for arthroscopic posterior labral repair include symptomatic posterior labral tears identified on magnetic resonance imaging with or without contrast, that failed nonsurgical management (ie, lifestyle modification, nonsteroidal anti-inflammatory drug, and physical therapy). Patients may present with a positive posterior load and shift or positive posterior apprehension test. Technique Description: With the patient in the lateral decubitus position, use a standard posterior superior portal, an ancillary anterior superior portal, a posterior-inferior, and the portal of Wilmington. After portal placement and diagnostic arthroscopy, the torn labrum is debrided. The torn portion of the posterior labrum is then mobilized from approximately the 6 o’clock to 10 o’clock positions, and a curette and shaver are used to produce a bleeding margin for fixation. Two double-loaded 2.4-mm suture anchors are placed, passed, and tied; one at the 6:30 o’clock position and the other at the 8 o’clock position. A cinch stich configuration using a 2.9-mm pushlock anchor can be used at the 10 o’clock position. A polydioxanone suture is used to assist with capsular plication and to close the posterior portal. Results: The literature suggests that 90% to 94% of patients are able to return to their desired sport with 5% to 10% reporting recurrent instability by 2 years after operation. Two out of 3 patients report no limitations at 2 years. Discussion/Conclusion: Arthroscopic repair of posterior labral tears with suture anchors can be an effective surgical option for patients with reverse Bankart lesions. Using advanced imaging to identify concomitant pathologies, meticulous surgical technique, direct visualization of the anatomy and anchor placement, and a dedicated rehabilitation program, greater than 90% of patients can expect to return to sport.

Application Value of Magnetic Resonance Arthrography of the Shoulder in Nursing and Diagnosis of Patients with Shoulder Joint Injury.

Supraspinatus tendon injury is a common clinical shoulder joint disease and is one of the most common causes of shoulder pain and dysfunction. Supraspinatus tendon injury will lead to articular cartilage injury and degeneration, then cause joint disease, seriously affect the quality of life of patients, and bring a huge burden to the family and society. This paper mainly studies and evaluates the application value of special signs of shoulder joint and indirect MR imaging in the diagnosis of supraspinatus tendon injury. Through a series of special examinations for the diagnosis of supraspinatus tendon injury in 90 patients, including zero degree abduction resistance test, arm drop test, Jobe test, Neer sign, and Hawkins sign, all patients in the study underwent indirect magnetic resonance imaging of the shoulder joint. Finally, arthroscopic examination results were used as the “gold standard” to evaluate and analyze the diagnosis. The results showed that among the special signs, the specificity of the falling-arm test was the highest (72.2%) in the diagnosis of full-thickness supraspinatus tendon injury. Hawkins sign had the highest sensitivity (84.0%). In the diagnosis of partial supraspinatus tendon injury, the specificity of the Jobe test was the highest, which was 66.6%. The Neer sign had the highest sensitivity of 50.0%. In the diagnosis of full-thickness supraspinatus tendon injury, there was no significant difference in sensitivity between indirect MRI and Hawkins sign, but the diagnostic specificity of indirect MRI was higher than that of special sign examination. In the diagnosis of partial supraspinatus tendon injury, the sensitivity and specificity of indirect MR imaging are higher than those of special sign examination.

Real-time interactive digital healthcare system for post-operative breast cancer patients: study protocol for a randomized controlled trial

BackgroundAfter receiving breast cancer surgery or reconstruction, shoulder dysfunctions including weakness, post-operative pain, shoulder joint instability, and limited range of motion (ROM) often occur. Due to limited ROM, patients may suffer difficulty in activities of daily living, and quality of life may be reduced. The objective of this study is to compare the effects on shoulder ROM of a real-time interactive digital healthcare system and brochure-based home rehabilitation program in post-operative breast cancer patients.MethodsThis study is a prospective, multi-center, assessor-blinded randomized controlled trial. The study aims to recruit 100 breast cancer patients exhibiting limited shoulder ROM after undergoing axillary lymph node dissection or breast reconstruction following mastectomy. Patients will be randomly assigned to two groups for 8 weeks of rehabilitation: a digital healthcare system rehabilitation (intervention) group and a brochure-based rehabilitation (control) group. The primary outcome is the change in ROM of the affected shoulder between baseline and 12 weeks after enrollment. Secondary outcomes include pain in the affected shoulder, as measured using a numerical rating scale, functional outcomes (QuickDASH scores), and quality of life (FACT-B and EQ-5D-5L scores), all of which will be measured on enrollment and 4, 8, and 12 weeks thereafter.DiscussionThis study will compare the effectiveness of a newly developed, augmented reality-based real-time interactive digital healthcare system with that of brochure-based home rehabilitation for improving the shoulder ROM, pain, functional outcomes, and quality of life of post-operative breast cancer patients.Trial registrationClinicalTrials.govNCT04316156. Registered on 20 March 2020.

Anomalous origin of the long head of biceps in a patient with anterior shoulder instability and long-term results of its repair

The long head of the biceps tendon normally originates from the superior glenoid tubercle. There have been several descriptions of anomalous origins of the tendon of the biceps, but their clinical implications remain mostly unknown. They are mostly incidental findings during arthroscopic surgery and include aberrant origins and agenesis. Due to the rare nature of these lesions, it is unlikely that substantial sample size will be generated in the future to propose treatment recommendations. Nevertheless, shoulder arthroscopy surgeons should be aware of its potential to become pathologic and causing shoulder dysfunction. We are presenting a case of a young sportsperson who presented to us with a complaint of anterior instability and its long-term follow-up after repair. The anomalous origin of the biceps tendon was noted incidentally on arthroscopy while doing the repair though the patient did not report any pain due to the same both preoperatively and after surgery.

POST-SURGICAL SHOULDER REHABILITATION OF SELECTIVE NECK DISSECTION WITH PECTORALIS MAJOR MYOCUTANEOUS FLAP RECONSTRUCTION IN “SICK” SYNDROME PATIENTS

Selective neck dissection (SND) is a surgical procedure developed to remove cervical lymph nodes at the risk of invasion metastasis. It is distinguished from radical neck dissections wherein there is the retention of one or more groups of lymph nodes. In this case, a 45-year-old male shopkeeper diagnosed with malignancy of lower anterior alveolus from 45-36 region (stage IVA –T4a N2Cm0) underwent SND, segmental mandibulectomy, and reconstruction with pectoralis major myocutaneous flap (PMMC flap) on the left side. On assessment, before the SND, Scapular mal positioning, inferior medial border prominence, coracoid pain, and dyskinesia of scapular movement (SICK) were identified. The patient was referred for physiotherapy with the complaint of inability to maintain saturation, difficulty in decannulation, and shoulder dysfunction on postoperative day 3 (POD-3). Chest physiotherapy comprising of breathing and suctioning techniques aided early decannulation. Furthermore, a prompt shoulder rehabilitation program for six months had a positive impact on the overall functioning and quality of life of the patient.

Serratus Anterior Stretch: A Novel Intervention and Its Effect on the Shoulder Range of Motion.

Serratus anterior tightness is associated with scapular dyskinesis and overall shoulder dysfunction, which affects the range of motion. The most effective intervention to stretch the serratus anterior is unknown. To evaluate the effect of a therapist-administered novel serratus anterior stretch (SAS) on shoulder range of motion. This study recruited 30 healthy subjects of age 21.20 (1.69) years, height 1.65 (0.11)m, and weight 60.90 (10.36)kg in equal ratio of males and females who scored 1 or 2 on the shoulder mobility test of functional movement screening. A single intervention of a novel SAS was applied to the shoulder. Outcome variables before and after the SAS included the following: shoulder ROM (flexion, abduction, internal rotation, and external rotation) and functional movements of reaching up behind the back and reaching down behind the neck. A paired t test was used to analyze the data. Following the acute SAS intervention, all shoulder ROM improved significantly (P < .000). The change in internal rotation was 6.00° (7.47°), external rotation was 5.66° (9.35°), abduction was 13.50° (11.82°), flexion was 20° (13.33°), reaching up behind the back was 5.10 (2.21) cm, and reaching down behind the neck was 5.41 (2.89) cm. The most marked improvement was in reaching up behind the back (24.48%) and reaching down behind the neck (22.78%). A very large effect size (>1) was observed across most of the variables. An acute SAS intervention improves shoulder mobility in healthy individuals. It is recommended for the trial on the prevention and rehabilitation of shoulder pathologies with restriction in shoulder mobility.

Progression to Glenohumeral Arthritis after Arthroscopic Posterior Stabilization in a Young and High Demand Population

Objectives:Shoulder instability is a common cause of shoulder pain and dysfunction, particularly in young and active individuals. While anterior instability remains the most common type, recent literature shows that posterior instability occurs more frequently than previously thought. As opposed to its anterior counterpart, posterior instability most often presents with pain, particularly in active individuals involved in dynamic posterior loading of the shoulder resulting in repetitive microtrauma of the posterior capsulolabral structures. While arthroscopic stabilization for posterior glenohumeral instability has shown excellent success preventing recurrent instability and allowing return to sport, eventual progression to glenohumeral arthritis remains a concern in these patients. However, the rate of and risk factors for arthritis post-surgery in young and high demand populations have not been described in the literature and may be important in guiding decision making when treating the young patient with posterior shoulder instability. The purpose of this study was to evaluate the rate of progression to glenohumeral arthritis and identify potential risk factors after arthroscopic posterior stabilization in a young and high demand population.Methods:This study included 110 active duty servicemembers identified in the Military Heath System (MHS) with ICD-9/ICD-10 posterior shoulder instability who underwent primary arthroscopic surgical stabilization and had postoperative imaging or medical records available over a twelve-year period between January 2004 and September 2016. All procedures were performed at a single institution. Patients were excluded if the they had previously undergone a stabilization procedure on the shoulder of interest, if no pre-operative imaging was available, if they did not have a minimum follow-up of four years, or if operative information regarding the number of anchors used was unavailable. Presence of arthritis (yes/no) was defined over follow-up using radiographic parameters as described by Samielson and Prieto identifying patients with at least ‘mild arthritis’. Kaplan-Meier survival curves were estimated for development of arthritis and compared by patient characteristics using log-rank tests. Cox proportional hazard models were used to calculate Hazard Ratios (HR) with 95% confidence intervals (95% CI) associated with patient characteristics as predictors of the development of glenohumeral arthritis.Results:Among the 110 patients with posterior shoulder instability requiring surgical fixation, 12% (13/110) developed glenohumeral arthritis. The mean age of all patients was 23.9 years (SD 6.71). The median time to diagnosis of arthritis was 7 years and the median follow-up time was 8 years (IQR 5;11). Kaplan-Meier curves showed differences in time to arthritis among patient groups stratified by age and index surgery anchor number (log rank p for each <0.05). Hazard ratios (95% CIs) estimated from separate Cox regression models of the development of glenohumeral arthritis were .344 (1.3262 to 8.431) for age in years (per SD) and 2.8280 (1.10577 to 7.233) for surgery anchor number.Conclusions:No previous study has reported the incidence and risk factors for glenohumeral arthritis after arthroscopic surgical stabilization for posterior shoulder instability. In the current study, generally young and high demand patient population, the rate of progression to glenohumeral arthritis after posterior stabilization surgery was 12%. Within this cohort, older age and higher number of anchors used were associated with progression to arthritis. The incidence of arthritis over follow up post surgery was lower than incidences previously described in older populations, a finding which may advocate for early surgical intervention for a young patient presenting with posterior shoulder instability.

“Ninja Technique” for Percutaneous Completion of Partial-Thickness, Articular-Sided Rotator Cuff Tears

Rotator cuff tears are a common source of shoulder pain and dysfunction. Owing to the multifaceted nature of these injuries, various viable methodologies exist for their surgical and nonsurgical management. Among surgically managed patients, those with PASTA (partial articular supraspinatus tendon avulsion) lesions require careful consideration of technique. Both transtendinous repair and tear completion with subsequent repair have been described. Both techniques offer unique benefits. In this publication, we offer an expedient and minimally invasive technique for tear completion and subsequent repair. The “ninja technique” uses localization via a spinal needle and tear completion with an arthroscopically manipulated scalpel blade. Conversion of partial tears to full-thickness tears using the ninja technique allows for technically simplified repairs while maximizing available tendon length.

A Comparison of Resting Scapular Posture and the Davies Closed Kinetic Chain Upper Extremity Stability Test.

BACKGROUNDIn orthopaedic practice, it is well established that weak scapular stabilizers and an unstable scapula is related to shoulder dysfunction. Faulty scapular position has been linked to decreased scapular stability and is thought to be a result of weak or unbalanced timing in the recruitment of scapulothoracic dynamic stabilizing muscles. Kibler has described a four-type classification of scapulothoracic dysfunction. Functional performance testing is used to objectively measure activities that simulate various desired activities. The reliability of assessing the four static scapular positions may be important in diagnosing shoulder dysfunction. An understanding of the scapular position and its relationship to functional performance testing is needed.PURPOSEThe purpose of this study was to determine if a static scapular test, the Kibler scapula classification, in healthy participants affects the ability to perform a closed chain functional test that involves the use of the scapula and the upper extremity, the Davies Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST). A secondary analysis was performed to evaluate the reliability of a student physical therapist and an experienced physical therapist to identify scapular type by observation.STUDY DESIGNMulticenter, single session descriptive cohortMETHODSSixty-one healthy participants (33 males, 28 females; mean age 24.19±2.61) completed testing across two locations in one testing session. Blood pressure and heart rate as well as height and weight were measured for each participant. Participants were classified by visual observation of Kibler scapular classification. The average number of CKUEST touches, a normalized score, and a power score were calculated for each participant. Three trials were performed and participants were required to take a 45-second rest break between each CKCUEST trial.RESULTSOne way analysis of variance (ANOVA) showed statistically significant differences in Type I and Type IV Kibler scapula classification for the CKCUEST power score, however when an ANCOVA controlled for body mass index, there was no statistically significant difference. A strong correlation r=.94 was observed between student and experienced physical therapist in evaluating all four types of Kibler scapular classification.CONCLUSIONSVisually observed Kibler scapular position does not affect the ability to perform the Davies CKCUEST in healthy young adults. The ability to identify Kibler scapular position was reliable between student and experienced physical therapists. Additional studies are required to identify the usefulness of the Kibler scapular position classification.LEVEL OF EVIDENCE2b: Individual Cohort Study

Elastofibroma presented as shoulder pain in an amateur swimmer: screening for referral in physiotherapy. A case report

ABSTRACT Elastofibroma is a benign and rare fibroblast/myofibroblast tumor usually located near the periosteum of the ribs. Patients with elastofibroma can remain asymptomatic or can experience a clicking sensation during shoulder movements, shoulder stiffness, scapular and shoulder pain and dysfunction. Importantly, the symptoms can mimic a musculoskeletal condition being mistaken for orthopedic shoulder joint disease. A 54 years-old amateur swimmer self-referred to physiotherapy for left subscapular and shoulder pain. Concerns from the patient’s history that caused suspicion of a medical condition included an insidious onset of nagging deep pain that increased with upper limb exertion and an audible thoracic clunk at arm end range flexion. Deep palpatory examination revealed a mass below the latissimus dorsi and rhomboids further screened by the physiotherapist with Rehabilitative Ultrasound Imaging. The physiotherapist referred the patient to a thoracic surgeon who removed the mass. After an exercise-based physiotherapy management program, the patient returned to previous activities including swimming after 5 months. The challenge for clinicians is to screen patients in whom shoulder pain may be related to non-musculoskeletal conditions. Prompt referral of patients presenting with the suspicion of elastofibroma to an appropriate physician may lead to a timely diagnosis and could avoid expensive and unnecessary rehabilitation procedures.

Glenohumeral Arthrodesis Using Pelvic Reconstruction Plates: a Series of 15 Patients

Glenohumeral joint arthrodesis has become a rare entity due to the introduction of shoulder arthroplasty. It is an excellent salvage procedure for patients with severe shoulder dysfunction, with limited treatment options, indicated for brachial plexus injury, tumour resection, chronic infection, failed prosthetic arthroplasty, or pseudoparalysis of the shoulder due to combined rotator cuff and deltoid deficiency. Shoulder arthrodesis relieves the patient of pain and gives a decent amount of function. The aim of this study was to examine the mid-term outcomes of glenohumeral arthrodesis with 2 pelvic recon plates. This study was done in a tertiary referral centre over a period of about 2 years. All the patients were operated on with 2AO 3.5mm recon plates and screws. Indications for surgery comprised unreconstructable rotator cuff tears, a neoplastic lesion, paralytic disorders, TB shoulder, arthritic disease unsuitable for arthroplasty, and sequelae of septic shoulder. Cancellous grafts were used in all operated patients, while a cortical graft was used in the tumour case to fill the bone defect after tumour excision. A minimum of 18 months was essential for inclusion into the study. 15 patients were included in the study. All the patients had decreased postoperative pain, which further decreased to pain-free status at further follow-up visits. All the arthrodeses produced bony union with average time to union of 5.4 months. All patients could feed and dress themselves with the ipsilateral limb. The only complication noted in this series was a superficial infection in 3 patients only, which subsided after wound wash, debridement and antibiotics for 10 days. 1. With specific indications, shoulder arthrodesis results in a good painless postoperative shoulder function and thus presents an excellent operative option. 2. The position of arthrodesis chosen here ensures that the arm rests comfortably at the side. 3. The patients can move their hands to their mouth and facial regions. 4. Recon plates should be used for arthrodesis because they are easy to shape without compromising on strength. 5. Few complications of procedure are there but it is a great therapeutic measure in selected individuals.

Animal models for study on rotator cuff injury.

Rotator cuff injuries are the most common cause of shoulder pain and dysfunction. Ideal animal shoulder models should have similar shoulder anatomy and function as human, and are able to replicate the microenvironment change after tendon injury. At present, a variety of animal models including rat, mouse, rabbit, sheep, canine, bovine, and primate have been used to study the mechanism of rotator cuff injury, effects of different repair techniques, and factors affecting tendon to bone healing. Although large animal models are more anatomically similar to humans, small animal models are more convenient in revealing the biological mechanism of rotator cuff injury and healing. Choosing appropriate animal models based on research objectives and establishing new small animal models play a critical role in revealing the mechanism of rotator cuff diseases and developing novel treating strategies.

The biomechanics of the rotator cuff in health and disease – A narrative review

The rotator cuff has an important role in the stability and function of the glenohumeral joint. It is a complex anatomic structure commonly affected by injury such as tendinopathy and cuff tears. The rotator cuff helps to provide a stabilising effect to the shoulder joint by compressing the humeral head against the glenoid cavity via the concavity compression mechanism. To appreciate the function of the cuff it is imperative to understand the normal biomechanics of the cuff as well as the mechanisms involved in the pathogenesis of cuff disease.The shoulder joint offers a wide range of motion due to the variety of rotational moments the cuff muscles are able to provide. In order for the joint to remain stable, the cuff creates a force couple around the glenohumeral joint with coordinated activation of adjacent muscles, which work together to contain the otherwise intrinsically unstable glenohumeral joint and prevent proximal migration of the humerus. Once this muscular balance is lost, increased translations or subluxation of the humeral head may result, leading to changes in the magnitude and direction of the joint reaction forces at the glenohumeral joint. These mechanical changes may then result in a number of clinical presentations of shoulder dysfunction, disease and pain.This narrative review aims to highlight the importance of functional rotator cuff biomechanics whilst assessing the kinetics and kinematics of the shoulder joint, as well as exploring the various factors involved in cuff disease.

Short- and Long-Term Effects of a Scapular-Focused Exercise Protocol for Patients with Shoulder Dysfunctions-A Prospective Cohort.

Current clinical practice lacks consistent evidence in the management of scapular dyskinesis. This study aims to determine the short- and long-term effects of a scapular-focused exercise protocol facilitated by real-time electromyographic biofeedback (EMGBF) on pain and function, in individuals with rotator cuff related pain syndrome (RCS) and anterior shoulder instability (ASI). One-hundred and eighty-three patients were divided into two groups (n = 117 RCS and n = 66 ASI) and guided through a structured exercise protocol, focusing on scapular dynamic control. Values of pain and function (shoulder pain and disability index (SPADI) questionnaire, complemented by the numeric pain rating scale (NPRS) and disabilities of the arm, shoulder, and hand (DASH) questionnaire) were assessed at the initial, 4-week, and 2-year follow-up and compared within and between. There were significant differences in pain and function improvement between the initial and 4-week assessments. There were no differences in the values of DASH 1st part and SPADI between the 4-week and 2-year follow-up. There were no differences between groups at the baseline and long-term, except for DASH 1st part and SPADI (p < 0.05). Only 29 patients (15.8%) had a recurrence episode at follow-up. These results provide valuable information on the positive results of the protocol in the short- and long-term.

Influence of smoking on clinical outcomes in shoulder surgeries among young population– a review article

ABSTRACT Tobacco smoking has a range of detrimental effects on the musculoskeletal system and is a risk factor for poor postoperative outcomes following various surgical operations. The study's objective was to look at the impact of smoking on shoulder operations and clinical results in the younger age group. According to the findings, smoking is linked to rotator cuff tears, shoulder dysfunction, and shoulder discomfort. Shoulder injuries involving several tendons are a severe problem for surgeons, and we must decrease the unfavourable risk factors by quitting smoking before shoulder surgery in order to have an optimal functional outcome. Keywords: Smoking, Rotator Cuff Tear, Arthroscopy, Shoulder, Tobacco, Rotator Cuff Tendinopathy.

A COMPARATIVE STUDY OF COMPLICATIONS OF MRM (MODIFIED RADICAL MASTECTOMY) VERSUS BCS (BREAST CONSERVATION THERAPY) IN EARLY INVASIVE BREAST CANCER. A RESULT FROM SAVERA CANCER AND MULTISPECIALITY HOSPITAL PATNA, BIHAR.

Background: Early breast cancer patients admitted in the surgical oncology department of Savera Cancer and Multispeciality Hospital. Patients were divided in two treatment arms; Arm A and Arm B. Arm A patient went through MRM and Arm B patients went through BCS. This study included prospective cases of 1 year from June 2019 to June 2020. Method: In all MRM group patients all breast tissue, skin, nipple areola complex and level 1, 2, 3 lymph nodes removed. In all BCS group patients lump was removed with an envelope of normal appearing breast tissue. In all resected specimens free surgical margin was ensured via histopathology reports (HPR). Patients were reviewed in early post operative period for complications and follow up done at the end of 1st, 3rd, 6th and 12th month for recurrence. In treatment Arm A (MRM) 08 patients developed arm ede Result: ma; 05 patients developed shoulder dysfunction; 07 patients developed ap necrosis; 07 patients developed arm dysesthesia. Whether in treatment ARM B (BCT) 04 patient had Seroma formation; 13 patients developed wound infection &amp; wound contracture. Complications were reported in 35% of MRM group (35 out of 100 cases), while they were absent in 65% (65 out of 100). However, in the BCS group, complications were reported in 6.66% cases only (15 out of 100 cases), while were absent in 93.33% (75 out of 100). P value by statistical analysis being 0.283, the difference being statistically insignicant. Recurrence were present in 6.66% of MRM group (8/100) while they were absent in 92.34 % (92/100). However in BCS group recurrences were present in 3.33 % (3/100) and were absent in 97.67% (97/100). P value by statistical analysis being 1, the difference being statistically insignicant. Grading of complications has been captured from CTCAE Version 5.0 (Common Terminology Criteria for Adverse Events). Conclusion: There is slight signicant difference in the recurrence rate, whether the patient had undergone BCS or MRM based on our short term follow-up. However a long term follow-up is required.