Shoulder Level Research Articles

The Impact of Prolonged Sitting Hours on the Correct Standing up Position of Elementary School Students in Developed Rural Area

At young ages the spinal column, which is the central support system of the human body, is susceptible to malformations, especially if the children are sitting in an incorrect position for long period. Our study examines the case of several elementary school students from a developed rural area. The aim of this study to analyze the impact of long sitting hours (5-6 hours) in incorrect position at on the normal standing up position at elementary school students. The study group for our study consisted of 80 elementary school students were recruited from a local rural elementary school. Each student was evaluated using a Kinect based system to determine their general standing up position. For 14 weeks, twice a week, each student has executed 5 type of Schroth exercises to improve their general body position. The first evaluation has shown that the students general standing up position is affected from the long sitting hours in the school benches. Most of them have shown misalignments at the shoulder and hip levels. In many cases one of the shoulders was higher than the other and the same is true for the hips as well. After 14 weeks of physiotherapy based on Schroth exercises the miss alignments were reduced to a bare minim. The results have shown that long sitting hours in incorrect positions can affect the spinal column and the standing up posture of the human body. In many cases malicious postures start to develop from childhood. If not treated they can transform in hyper-kyphotic and scoliotic postures which can induce other complications. If these malicious postures are observed in early stages of the children and with only 2 hours a week of physiotherapy based on Schroth exercise the postures can be corrected and the hyper-kyphotic and scoliotic postures can be avoided.

Bovine-derived xenograft in combination with autogenous bone chips versus xenograft alone for the augmentation of bony dehiscences around oral implants: A randomized, controlled, split-mouth clinical trial.

The aim of the study was to evaluate whether the use of a xenograft is not inferior to the use of xenograft and autogenous bone chips in treating dehiscences at implant placement. After implant placement, leaving a dehiscence, control sites were treated using a composite graft (autogenous bone chips and xenograft) and at the test sites 100% xenograft was used. Both sites were covered with a resorbable collagen membrane. Dehiscences were measured clinically at implant placement and at re-entry. CBCT was taken immediately after implant placement and after 4months. In total, 28 GBR procedures were performed in 14 patients. On average, the change in vertical defect height was 2.07mm (46.7%-test group) and 2.28mm (50.9%-control group) (p>.05). The horizontal defect width at the implant shoulder change on average 1.85mm (40.5%-test group) and 1.75mm (40.9%-control group) (p>.05). On average, a loss in augmentation thickness of 0.45mm (68.9%-test group) and 0.64mm (55.5% control group) between implant placement and augmentation and abutment surgery was obtained at the implant shoulder. Both treatment modalities seem to work to a certain extent. At implant shoulder level, the augmentation thickness seems to be disappeared after the healing phase. (NCT03946020).

Effects of Passive Upper-Extremity Exoskeleton Use on Motor Performance in a Precision Task

Upper-extremity exoskeletons (UEXO) are promising interventions for reducing the physical demands of work performed with arms elevated (e.g., overhead work). In this study, we investigated the effects of passive UEXO use on motor performance and physical demands in a repetitive precision overhead task. Eleven participants completed repetitive tapping of targets in both vertically-aligned (targets above/below shoulder level) and horizontally-aligned (targets at shoulder level) configurations, using two UEXOs (Levitate AirframeTM and Eksobionics EksoVestTM) and in a no-device (control) condition. Median levels of muscle activity in the upper trapezius and anterior deltoid muscles decreased using both UEXOs compared to the control. However, the two UEXOs caused distinct effects on end-point precision. End-point precision was similar between devices in the horizontal configuration, but using the EksoVest significantly decreased precision in the vertically-aligned task. These results indicate that task performance may be device-specific, and should be considered when using industrial exoskeletons in diverse tasks.

Euscorpius flavicaudis sting is not lethal but not harmless either: First record of neurological symptoms in child after sting

Five scorpion species live in France: Buthus occitanus, Belisarius xambeui, Euscorpius flavicaudis, Euscorpius carpathicus and Euscorpius italicus. The species of the genus Euscorpius have a body color ranging from brown to black with yellow or orange-brown legs and tail. From the literature, we know that Euscorpius’ sting can induce nausea, vomiting and tachycardia. In the south of France, on January 2019, a 10-year-old boy had his hand stung by a black bodied and yellow legged and tailed scorpion. The symptoms following the sting were: local pain up to the shoulder, paresthesia, pruritus, sweating, some painful abdominal cramp, an inability to lift the arm above the shoulder level, a decreasing muscular strength, hypoesthesia and a transient fasciculation. Symptoms disappeared after 72 h. This is a grade II envenomation according to the Khattabi classification. Having been stung by similar scorpions before, the child had, until now, only experienced local pain, sweating, hyperthermia, abdominal pain and vomiting. As the scorpion species was not collected or photographed, it was identified using a map showing the known locations of the different species known to France. This is the first case report of neurological symptoms in an envenomation by a Euscorpius flavicaudis. This severity is due to the patient's vulnerability (children, low weight) and low scorpion activity (winter, high humidity) that increases envenomation potential.

Physical and psychosocial work exposures as risk factors for disability retirement due to a shoulder lesion

ObjectiveTo assess the longitudinal associations of physical and psychosocial exposures with disability retirement due to a shoulder lesion.MethodsIn a nationwide register-based study, we followed 1 135 654 wage earners aged...

Upper-limb actuated exoskeleton for muscular dystrophy patients: preliminary results.

Being able to perform a lost movement is an important experience towards increased independence and self-esteem, particularly for neuromuscular patients, who see their muscles weaken day after day. In this pilot study, preliminary results on the testing of a motorized upper-limb exoskeleton for muscular dystrophy patients are presented. The mechatronic system is a five Degrees of Freedom exoskeleton, which acts at shoulder, elbow, and wrist levels. It is designed to help severely impaired people to regain independence during daily-life activities. While wearing the exoskeleton, the user has the direct control of the system by actively piloting the position of end-effector by means of joystick or vocal control. The usability of the system and a quantitative assessment of arm functionality with and without the exoskeleton are evaluated on five muscular dystrophy patients. According to the objective functional benefit evaluation performed through the PUL scale, all participants strongly increased their range of motion and they were able to perform activities that were not possible without the exoskeleton, such as such as feeding, playing activities at the table, combing hair or using a keyboard. As for the evaluation of self-perceived functional benefit, four patients reflected the effective measured functional improvement. System usability has been evaluated to be good.

A Randomized Controlled Clinical Trial Comparing Conventional and Computer-Assisted Implant Planning and Placement in Partially Edentulous Patients. Part 4: Accuracy of Implant Placement.

The objective of this study was to compare the accuracy of conventional and computer-assisted implant planning and template-guided placement (CAIPP) protocols. Partially edentulous patients (N = 73) were randomly assigned to either a conventional implant planning and freehand placement protocol (control group, n = 26) or one of two different CAIPP protocols (stereolithographic guide [T1, n = 24] or 3D-printed guide [T2, n = 23]). The virtually planned and final implant positions were compared. Differences between the planned and the obtained implant position were evaluated as horizontal, vertical, and angular measurements. Descriptive statistics were calculated for overall deviation values and their fragmented mesiodistal and bucco-oral vectors at each evaluation plane. To study overall accuracy differences between study groups, analysis of variance (ANOVA) was used with Bonferroni post hoc test (Scheffé method). Possible confounding variables were analyzed using multiple linear regression with respect to treatment group. The mesiodistal or bucco-oral distribution of the positioning errors was evaluated with chi-square test. A multiple linear logistic regression was used to identify confounding variables. Inaccuracy at the level of the occlusal plane of the restoration averaged 0.65 ± 0.26 mm in the control group, 0.59 ± 0.4 mm in T1, and 0.76 ± 0.5 mm in T2. At the implant shoulder level, the inaccuracy amounted to 1.25 ± 0.62 mm, 0.97 ± 0.36 mm, and 0.72 ± 0.31 mm in the control group, T1, and T2, respectively. At the implant apex, mean deviations of 2.32 ± 1.24 mm were recorded in the control group, 0.97 ± 0.57 mm in T1, and 1.08 ± 0.57 mm in T2. Mean discrepancies in vertical direction measured 0.28 ± 1.01 mm (control), 0.2 ± 0.65 mm (T1), and -0.1 mm ± 1.0 mm (T2). Angular deviations of 7.36 ± 3.36 degrees (control), 4.23 ± 2.68 degrees (T1), and 3.13 ± 2.12 degrees (T2) were measured. Statistically significant differences were observed between the conventional and the two CAIPP groups for overall deviations at implant shoulder, apex, and implant angulation. CAIPP protocols seemed to provide a higher accuracy and precision compared to conventional freehand protocols. Still, the amount of inaccuracy using guides demands a safety margin. Moreover, intrasurgical verification during drilling and the implant placement procedure should be performed, including clinical parameters that may not be available from cone beam computed tomography data during the planning phase.

Value of Anterior Band of the Inferior Glenohumeral Ligament Area as a Morphological Parameter of Adhesive Capsulitis

Objective Thickened inferior glenohumeral ligament (IGHL) is considered as one of the major morphological parameters of adhesive capsulitis (AC). Previous studies reported that the anterior band of inferior glenohumeral ligament thickness (aIGHLT) is correlated with shoulder capsular contracture, luxatio erecta humeri, and AC. However, the thickness varies from the measured angle. To reduce this measurement error, we devised a new morphological parameter, called the anterior band of inferior glenohumeral ligament area (aIGHLA). Methods The aIGHL samples were collected from 54 patients with AC and from 50 control subjects who underwent shoulder magnetic resonance imaging (MRI) without any evidence of AC. Coronal T2-weighted MRI images were obtained at the shoulder level from each patient. We measured the aIGHLA and aIGHLT at the maximal view of the IGHL in the coronal plane using our picture archiving and communication system. The aIGHLA was measured at the whole cross-sectional area of the IGHL in the most hypertrophied segment of the coronal MR images. The aIGHLT was measured at the thickest point of the IGHL. Results The average aIGHLA was 55.58 ± 14.16 mm2 in the control group and 83.71 ± 28.45 mm2 in the AC group. The average aIGHLT was 3.47 ± 0.99 mm in the control group and 4.52 ± 1.02 mm in the AC group. AC patients showed significantly greater aIGHLA (p < 0.001) and aIGHLT (p < 0.001) than control subjects. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off score of the aIGHLA was 63.37 mm2, with 79.6% sensitivity, 80.0% specificity, and AUC of 0.84 (95% CI, 0.76–0.92). The optimal cut-off point of the IGHLT was 3.81 mm, with 74.1% sensitivity, 74.0% specificity, and AUC of 0.77 (95% CI, 0.68–0.86). Conclusions Although the aIGHLA and aIGHLT were both significantly associated with AC, the aIGHLA was a more sensitive diagnostic parameter.

An advanced junction concept in pediatric craniospinal irradiation by proton pencil beam scanning

PurposeTo present an advanced junction concept in craniospinal irradiation (CSI) by proton pencil beam scanning (PBS). Materials and methodsIn PBS CSI, whole brain irradiation (WBI) is commonly delivered by opposed lateral-beams, whereas spine irradiation is delivered by posterior entrances. Since lateral-beams would cross a large portion of the patient at the shoulder level, the junction between WBI and spine irradiation cannot extend below that level, thus the size of the lateral-beams needs to be limited and the number of required isocenters can increase. To overcome such limitation, a pseudo-junction was introduced below the posterior fossa, to turn in this region the WBI beam arrangement to a single posterior beam pointed at the same isocenter, that was matched to the posterior spinal beam more caudally, below shoulder level, in the true-junction. After assessing robustness of the technique to range and setup uncertainties, twenty-three treated patients were reviewed to estimate the percentage that might benefit of being treated by two instead of three isocenters. ResultsTarget coverage at the junction levels resulted robust, with D95% > 95% on pseudo-junction and D95% > 90% on the true-junction. By the advanced junction concept, 91% of patients might by treated with only two isocenters, whereas, by the conventional method, 83% of patients required three isocenters. ConclusionWith the presented junction concept the number of isocenters can be reduced, with a consequent relevant reduction of treatment time, which is particularly valuable in the management of pediatric patients under anesthesia.

Could long-term overhead load in painters be associated with rotator cuff lesions? A pilot study.

BackgroundUse of the arm above shoulder level has been described as a risk factor for developing rotator cuff tears (RCT). There is a lack of information regarding the frequency and distribution of RCT in a population using their arms above shoulder level during daily work. The aim of this study was to analyze clinical and radiographic findings in a population of painters working more than 10 years and to compare the results with a control group (CG)Materials and methods100 individuals working more than 10 years as a painter were compared to 100 matched controls without using their arms above shoulder level. MRI scans were performed in all participants. Clinically, the Constant score, DASH score and range of motion (ROM) of the shoulders were analyzed.ResultsIn the painter group (PG) a tear of the supraspinatus tendon was detected in 45% (10%full-thickness; 35% partial) compared to 8% in the (CG) (3% full-thickness; 5%partial; p<0.001). Impingement test was painful in 52% of PG and 7% of CG (p<0.001). The Constant score in the PG was significantly lower compared to the CG (62 vs. 93 points; p<0.001). PG had significantly worse DASH scores and inferior active and passive ROM of the dominant shoulders. In the multivariable logistic regression analysis, three risk factors (smoking, sports activity, and handedness) showed no effect. However, group membership (PG/CG) and age revealed a significant effect.ConclusionLong-term occupational load on the shoulders in painters seems to be associated with an increased risk for developing RCT. Our findings may provide support for developing preventive strategies for this unique cohort.Level of evidence: III

Sex differences in upper limb 3D joint contributions during a lifting task

Sex-related differences in work technique may contribute to increasing the risk of musculoskeletal joint disorders among women. In lifting tasks, sex differences have been reported for the trunk and lower limb, although women present a higher prevalence of shoulder disorders. We investigated sex differences in the upper limb technique during a lifting task. Trunk and upper limb kinematics were recorded in 27 women and 27 men lifting a box (6 or 12 kg) from hip to eye level. Work technique was quantified through the three-dimensional contribution of each joint to overall box height. The glenohumeral joint showed a higher contribution in women with a 6 kg box and wrist and elbow joints did with a 12 kg box, compared to men at either 6 or 12 kg. Sex differences occurred systematically above shoulder level. Our results argue for careful consideration of sex during ergonomic intervention, particularly during the overhead task.Practitioner Summary: We investigated the sex-related differences in upper limb technique during lifting tasks. Results highlight a sex-specific kinematic strategy above the shoulder level on the glenohumeral joint and on the wrist and elbow joints. To help reduce women’s shoulder disorders in overhead task, ergonomic interventions should account for those differences.Abbreviations: DoF: degree-of-freedom; WR/EL: wrist and elbow; GH: glenohumeral; SC/AC: sternoclavicular and acromioclavicular; TR/PE: pelvo-thoracic

De volta ao meio líquido: efeitos da intervenção de fisioterapia aquática realizada em prematuros

At birth, preterm newborns (PTNB) often require Neonatal-ICU hospitalization, which, despite being a care setting, also causes stress such as pain, sleep disturbances and wakefulness, and alterations of physiological parameters. The aim of this study was to analyze the effects of aquatic physiotherapy on pain, sleep disturbances and wakefulness, and physiological variables of PTNB in Neonatal-ICU. Pain, sleep disturbances and wakefulness, and alterations of physiological parameters were evaluated at three moments: 5 minutes before intervention, immediately after and 10 minutes after intervention. At intervention, participants were wrapped in soft fabric and immersed at shoulder level in warm water (36 °C to 37.5 °C). Sideways, forward, backward and rotational movements were performed. Twenty-two newborns participated in the study. The results obtained in relation to pain, sleep state and wakefulness showed significant improvements in reevaluations after intervention. Physiological variables also underwent significant changes and remained within normality parameters. The results indicate that aquatic physiotherapy is effective in reducing pain, improving sleep and wakefulness and physiological variables of PTNB in Neonatal-ICU.

A prospective analysis of motion and deformity at the shoulder level in surgically treated adolescent idiopathic scoliosis

BackgroundAlthough posterior spinal correction and fusion surgery (PSF) of adolescent idiopathic scoliosis (AIS) limits counter rotation between thorax and pelvis, the physical function, and more specifically gait of these patients is only slightly affected after PSF. Possibly, shoulders-thorax counter-rotation increases to compensate for the loss in thorax-pelvis motion. This would subsequently result in a higher phase-difference and range of motion (ROM) between the shoulders and thorax. Research questionsWhat is the effect of PSF on the phase difference and ROM between the shoulders and thorax? What is the effect of PSF on upper body deformity? Methods18 AIS patients underwent gait analysis at increasing walking speeds (0.45 to 2.22 m/s) before, and 3 and 12 months after PSF. The phase difference, ROM, and deformity between the shoulders, thorax, and pelvis were calculated. ResultsThe shoulders- thorax phase difference was unaffected by surgery. At 3 months postoperatively the shoulders-thorax ROM was decreased (3.5° ± 0.2° versus 2.7° ± 0.2°, p=0.001). This recovered to preoperative values 12 months postoperatively (3.2° ± 0.2°, p=0.213). The shoulder-pelvis phase difference was decreased 3 months postoperatively (−98.9° ± 6.8° vs. −77.2° ± 7.2°, p=0.010), and recovered to pre-op values at the 12 months postoperative measurement (−89.6° ± 6.9°, p=0.290). Walking speed did not influence the effect of surgery on phase difference or ROM. The pre-operative shoulders-thorax asymmetry decreased from 3.4° ± 2.4° to 0.6° ± 3.1° (p<0.001). Shoulders-pelvis and thorax-pelvis asymmetry decreased from 10.0° ± 3.7° to 2.8° ± 4.3° (p<0.001) and from 6.5° ± 3.4° to 1.8° ± 3.2° (p=0.006) respectively. SignificanceNo compensatory mechanisms could be identified in the relative motion between the shoulders and the thorax. Possibly, compensatory mechanisms are not required for normal gait after surgery. The asymmetry of the shoulders in the transversal plane improved without specific surgical strategies.

A Manual Therapy and Home Stretching Program in Patients With Primary Frozen Shoulder Contracture Syndrome: A Case Series.

Manual therapy has been demonstrated to reduce pain and improve function in patients with frozen shoulder contracture syndrome (FSCS), but no evidence exists to support one form of manual therapy over another. This case series describes both short- and long-term outcomes after a manual therapy program and home stretching exercises based on specific impairments in shoulder mobility and level of tissue irritability in patients with FSCS. Eleven patients with primary FSCS were treated with an individually tailored, multimodal manual therapy approach once weekly for 12 visits, coupled with home stretching exercises once a day, 5 days per week. Pain, disability, range of motion (ROM), and muscle strength of the affected shoulder were assessed at baseline, posttreatment, at 6 months, and at 9 months. Significant improvements in self-reported pain, disability, shoulder ROM, and strength were reported following treatment. Additionally, 4 of 11 patients showed pain improvements that exceeded the minimal clinically important difference (MCID) on the visual analog scale postintervention, and 8 of 11 showed pain improvements at 6 and 9 months. Moreover, 7 of 11 patients showed improvements in Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores exceeding the MCID postintervention and at 6 months, and 8 of 11 exceeded the MCID at 9 months. Clinically meaningful changes in shoulder pain and disability, ROM, or muscle strength were observed in 11 patients with primary FSCS treated with an individually tailored approach of both manual therapy techniques and stretching exercises, accounting for tissue irritability. Therapy, level 5. J Orthop Sports Phys Ther 2019;49(3):192-201. Epub 18 Jan 2019. doi:10.2519/jospt.2019.8194.

Are there sex differences in muscle coordination of the upper girdle during a sustained motor task?

PurposeThe higher prevalence of work-related musculoskeletal disorders among women compared with men could be explained by sex-gender differences related to biological and physiological processes. The aim of this study was to evaluate sex differences in motor coordination during a sustained and repetitive motor task. MethodsSeventeen healthy females and 21 healthy males participated. The surface electromyography (sEMG) of the trapezius portions and serratus anterior were recorded. Root mean square (RMS) values were computed to assess the level of muscle activity. The standard deviation (SD) and coefficient of variation (CV) were computed as metrics of size of variability. The normalized mutual information (NMI) values were calculated as index of functional connectivity between muscles pairs. ResultsFemales had higher normalized RMS values for the upper trapezius (acromial fibers) and serratus anterior muscles compared with males. RMS decreased, SD and CV increased while NMI decreased for almost all muscle pairs over time. ConclusionThe present work showed some signs of sex differences in muscle coordination of the shoulder girdle during a sustained motor task, performed with the upper limb positioned below of the shoulder level.

Retrospective cohort study of a tapered implant with high primary stability in patients with local and systemic risk factors\u20147-year data

ObjectivesThis retrospective study examined the mid- to long-term clinical and radiographic performance of a tapered implant in various treatment protocols in patients with local and systemic risk factors (RFs).Material and methodsTwo hundred seven NobelActive implants were inserted in 98 patients in the period from 10/2008 to 02/2015. The subdivision of the cohort was defined by local (n = 40), systemic (n = 6), local and systemic (n = 8), or without any RFs (n = 44) to analyze implant survival and marginal bone levels.ResultsFifteen implants failed within the follow-up period. The mean follow-up period of the remaining implants was 34 months (range 12 to 77 months). The cumulative survival rate according to Kaplan-Meier was 91.5%. The survival rate for 93 implants in 45 patients with no RFs was 94.8% whereas it was 94% for 83 implants in 48 patients with local RFs (p = 0.618), 81.3% for 14 implants in 6 patients with systemic RFs (p = 0.173), and 76.5% for 17 implants in 6 patients with local and systemic risk factors (p = 0.006). The interproximal marginal bone level was − 0.49 ± 0.83 mm at the mesial aspect and − 0.51 ± 0.82 mm at the distal aspect in relation to implant shoulder level and showed no relevant difference in the various risk factor groups.ConclusionsIt can be assumed that the negative effects of the local or/and systemic risk factors were partially compensated by the primary stability and grade of osseointegration of the NobelActive implant.Clinical relevanceThe use of this system in patients with risk factors and immediate loading procedures.

A rare presentation of anthrax with sepsis: A case report

Anthrax is a zoonotic infection caused by Bacillus anthracis. Although the incidence of the disease is decreasing in our country, it is still endemic in certain regions of the country. The cutaneous form of the disease is the most common clinical form, which is usually benign and rarely causes bacteriemia and sepsis. In this case report, a cutaneous anthrax case who had positive blood and wound cultures and were complicated with sepsis are presented. A 39-years-old male patient living in Kars (Eastern Turkey) was admitted with systemic fever, chills,and a wound with swelling redness on the right arm. In his medical history, the patient stated an insect (fly) bite three days ago and consequent development of a lesion on his right arm. He also stated that he had slaughtered a lamb 10 days ago by himself. On admission, the patient was detected to have a 2-3 cm centrally necrotic and peripherally edematous wound confined to the right forehand. There was also fever, hyperemia and general edema confined to right arm up to the shoulder level. With the preliminary diagnosis of cutaneous anthrax, the patient was hospitalized, and ampicillin-sulbactam therapy was started, but due to the progression of the lesion and clinical deterioration, the treatment was changed to piperacillin-tazobactam and clindamycin. The swab samples from the wound were sent to the laboratory and revealed Gram-positive sporulated bacilli and following blood cultures were also positive for growth. The agent pathogen was identified as B.anthracis by Gram stains from wound samples and blood cultures which was susceptible to penicillin. MLVA method with 25 loci was used for genotyping, and it was determined that the genotype in our case is GK43 that is located in the major cluster A and subset 3. On the tenth day of hospitalization due to the widespread and necrotic lesions on his arm , compartment syndrome had been occurred. Escharatomy had been established for the treatment of comparment syndrome. After three weeks of antibiotherapy, the patient has been discharged from the hospital with good health.As a conclusion, this case report reminds need of high attention to the clinical course of cutaneous anthrax in order to avoid severe complications such as sepsis.

Rasterstereography versus radiography for assessing shoulder balance in idiopathic scoliosis: A validation study relative to patients' self-image.

Shoulder imbalance is a problem for scoliosis patients. Rasterstereography uses radiation-free surface topography to follow up these patients. Its use for assessing shoulder level has not been investigated earlier. This study aimed to determine the accuracy of shoulder assessment using rasterstereography (versus radiography) and to analyze its relationship with patients' self-image. In a cross-sectional setting, the reliability and validity of five rasterstereographic shoulder variables were measured in comparison with six radiographic shoulder parameters, using correlation analysis. The patients' self-perception was documented using the Scoliosis Research Society-22 (SRS-22) questionnaire and Trunk Appearance Perception Scale (TAPS). Forty patients were included in the study. The test-retest reliability of all rasterstereographic shoulder parameters was excellent (ICC > 0.95). The validity was moderate in comparison with six radiographic parameters (highest coefficient: 0.582). The radiographic and rasterstereographic shoulder levels correlated with the results in the SRS-22 questionnaire (highest coefficient: -0.463) and TAPS (highest coefficient: 0.413). Rasterstereography is a reliable and valid method for assessing shoulder level in idiopathic scoliosis. The parameters can be recommended as a complement to radiography and clinical evaluation for follow-up purposes. Radiographic and rasterstereographic shoulder parameters are significantly related to patients' self-perception. Shoulder variables thus need to be considered in scoliosis patients.

Open versus arthroscopic surgery in acromioclavicular separation

Acromioclavicular separation is a very serious injury at the level of shoulder. Lesion of the acromioclavicular joint is a usual clinical condition because of its superficial situation. It is often involved in trauma of the shoulder girdle. Rockwood classification involves VI types of modifications. First three types are treated conservatively, type IV to VI surgically. Arthroscopic techniques, lead to same middle and long-term results as open surgery. Arthroscopic procedures have theoretical advantages of no deltoid disruption and may help the surgeon to diagnose and treat associated lesions such as rotator cuff ruptures. More recently, arthroscopic surgeries for fresh and/or chronic acromioclavicular disjunctions were proposed. We analyzed 13 cases of acromioclavicular separation: 7 cases were treated with open surgery and 6 arthroscopically using tightrope, or dog bone button.

Clinical effectiveness and safety of the extended humeral head arthroplasty for selected patients with rotator cuff tear arthropathy

Cuff tear arthropathy is commonly managed with a reverse total shoulder arthroplasty (RTSA). A humeral hemiarthroplasty with an extended humeral head may provide a less invasive alternative for selected patients with cuff tear arthropathy if the shoulder has preserved active elevation. Because evidence regarding this procedure is limited, we investigated its safety and efficacy in treating selected patients with cuff tear arthropathy. We analyzed the preoperative characteristics, surgical findings, and clinical outcomes for patients selected for extended head hemiarthroplasty. For 42 patients with 2-year follow-up, there were no complications or revisions. The Simple Shoulder Test score improved from a median of 3.0 to 8.0 (P < .001). The median percentage of maximal possible improvement was 50% (P < .001). The percentage of patients able to perform each of the functions of the Simple Shoulder Test was significantly improved; for example, the ability to sleep comfortably increased from 19% to 71%, and the ability to place a coin on the shelf at shoulder level increased from 38% to 86% (P < .001). There are circumstances in which RTSA is clearly the preferred procedure for cuff tear arthropathy, including pseudoparalysis, anterosuperior escape, and glenohumeral instability; however, in shoulders with preserved active motion and stability of the humeral head provided by an intact coracoacromial arch, the extended head humeral arthroplasty can enable selected patients to realize improved comfort and function without the potential risks of RTSA. Extended humeral head hemiarthroplasty can provide a safe and effective alternative for the management of selected patients with rotator cuff tear arthropathy and preserved active motion.