Shoulder Motion Research Articles

Defining characteristics of independent walking persons after stroke presenting with different arm swing coordination patterns

BackgroundPersons after stroke present with an altered arm swing during walking. Given the known influence of the arm swing on gait, it is important to identify the characteristics of persons with stroke with different arm-to-leg coordination patterns during walking. MethodsTwenty-five persons after stroke walked on a self-paced treadmill at comfortable walking speed. The frequency of shoulder movements per stride was detected by Fast Fourier transform analysis on the kinematic data for hemiplegic shoulder movements in the sagittal plane. An independent-sample t-test or Mann-Whitney U test was used to compare clinical and biomechanical parameters between identified subgroups. ResultsTwo earlier described subgroups based on the number of shoulder flexion-extension movements during one stride could be confirmed. Participants in the 1:1 ratio subgroup (one arm swing during one stride, N = 15) presented with a less upper limb impairment and less spasticity of the elbow extensors (p = 0.012) than the participants in the 2:1 ratio subgroup (two arm swings during one stride, N = 9). Although not significant, the participants in the 1:1 subgroup also seemed to have less spasticity of the shoulder internal rotators (p = 0.06) and a less walking variability based on the standard deviation of the step width. Further research on a greater sample should confirm these findings. ConclusionFast Fourier transform analysis was used to identify subgroups based on sagittal shoulder kinematics during walking. The clinical and gait related differences between the identified subgroups can be taken into account in future research investigating post-stroke gait interventions aiming to improve the arm swing.

The effect of additional postural neck muscle control on conventional physiotherapy rehabilitation in reducing shoulder pain and disability in recreational surfers

Background: Shoulder pain and disability is a disorder commonly experienced by surfers, which is characterized by pain and limitations in the shoulder region when performing functional movements. Shoulder movement is closely related to the surfer's paddling movements when surfing, so high paddling intensity increases the risk of complaints in the shoulder region. This research aimed to prove that adding postural muscle neck control to conventional physiotherapy rehabilitation intervention was more effective in reducing shoulder pain and disability than conventional physiotherapy rehabilitation intervention.
 Methods: This research was experimental with a randomized pre- and post-test two-group design. Research participants were randomly divided into two groups. This research measured shoulder disability using the shoulder pain and disability index (SPADI) questionnaire.
 Results: The paired T-test analysis showed significant differences in the reduction in SPADI scores in group intervention, which was 23.2±2.7 with p-value< 0.001, and in group control, was 20.15± 3.3 with p-value< 0.001 in the patient's shoulder functional increase. The independent T-test obtained a p-value of 0.002, proving a significant difference between the intervention and control groups in reducing shoulder disability among recreational surfers.
 Conclusion: There were significant differences in SPADI scores before and after both group interventions. In addition, data showed that the additional postural neck muscle exercise on conventional physiotherapy rehabilitation obtained better improvement in shoulder disability than conventional physiotherapy intervention only among recreational surfers.
 Keywords: Conventional physiotherapy rehabilitation, postural muscle neck control, recreational surfers, shoulder pain and disability

Elastic Resistance and Shoulder Movement Patterns: An Analysis of Reaching Tasks Based on Proprioception.

This study departs from the conventional research on horizontal plane reach movements by examining human motor control strategies in vertical plane elastic load reach movements conducted without visual feedback. Here, participants performed shoulder presses with elastic resistances at low, moderate, and high intensities without access to visual information about their hand position, relying exclusively on proprioceptive feedback and synchronizing their movements with a metronome set at a 3 s interval. The results revealed consistent performance symmetry across different intensities in terms of the reach speed (p = 0.254-0.736), return speed (p = 0.205-0.882), and movement distance (p = 0.480-0.919). This discovery underscores the human capacity to uphold bilateral symmetry in movement execution when relying solely on proprioception. Furthermore, this study observed an asymmetric velocity profile where the reach duration remained consistent irrespective of the load (1.15 s), whereas the return duration increased with higher loads (1.39 s-1.45 s). These findings suggest that, in the absence of visual feedback, the asymmetric velocity profile does not result from the execution of the action but rather represents a deliberate deceleration post-reach aimed at achieving the target position as generated by the brain's internal model. These findings hold significant implications for interpreting rehabilitation approaches under settings devoid of visual feedback.

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.

The long head of the biceps tendon undergoes multiaxial deformation during shoulder motion

The long head biceps tendon (LHBT) is presumed a common source of shoulder joint pain and injury. Despite common LHBT pathologies, diagnosis and preferred treatment remain frequently debated. This Short Communication reports the development of a subject-specific finite element model of the shoulder joint based on one subject’s 3D reconstructed anatomy and 3D in vivo kinematics recorded from bone-fixed electromagnetic sensors. The primary purpose of this study was to use the developed finite element model to investigate the LHBT mechanical environment during a typical shoulder motion of arm raising. Furthermore, this study aimed to assess the viability of material models derived from uniaxial tensile tests for accurate simulation of in vivo motion. The findings of our simulations indicate that the LHBT undergoes complex multidimensional deformations. As such, uniaxial material properties reported in the existing body of literature are not sufficient to simulate accurately the in vivo mechanical behavior of the LHBT. Further experimental tests on cadaveric specimens, such as biaxial tension and combinations of tension and torsion, are needed to describe fully the mechanical behavior of the LHBT and investigate its mechanisms of injury.

Comparing the seoi-nage skill of elite and non-elite judo athletes

Seoi-nage performance requires a high level of skill and proficiency. The aim of this study was to compare the motor planning, regulation, and control skills of elite versus non-elite seoi-nage judo athletes. Twenty subjects (10 elites and 10 non-elite) performed the three-phase seoi-nage skills of unbalancing, positioning, and throwing while an optical motion capture 3D camera monitored their shoulder, pelvis, hip, and knee joint movements to calculate their force magnitude and direction. Elite athletes performed better than non-elite athletes in terms of the shoulder (247.4° vs. 208.3° in Event 4) and pelvic (235.4° vs. 194.4° in Event 4) rotation, tilt angle (15.13° vs. − 0.74° in Event 4) characteristics, as well as hip (136.1° vs. 125.0° in Event 4) and knee joint (124.0° vs. 120.8° in Event 3) flexion–extension angle. Compared to non-elite athletes, elite athletes also showed more controlled force and movement in all bodily areas. These results can help to guide the development of seoi-nage skills as judo athletes advance from the non-elite to the elite level.

Restudy of shoulder motion in the theropod dinosaur Mononykus olecranus (Alvarezsauridae)

Background Range of motion in the forelimb of the Upper Cretaceous theropod dinosaur Mononykus olecranus, a member of the family Alvarezsauridae, has previously been investigated. However, the method used to investigate range of motion at the shoulder in M. olecranus did not follow the standardized procedure used in subsequent studies. The latter procedure yields more reliable results, and its standardization provides that its results are directly comparable to the results of similar studies in other species. I therefore reinvestigated the range of motion at the shoulder in M. olecranus, using the latter procedure. Methods Casts of the left scapula and coracoid of M. olecranus were posed on a horizontal surface, supported from beneath with modeling clay, with the medial surface of the scapula facing toward the horizontal surface. A cast of the left humerus was posed at the limits of motion through the transverse and parasagittal planes. Photos of the poses in orthal views were superimposed and used to measure range of motion, which was measured as the angle between lines drawn down the long axis of the humerus in each position. Results Through the transverse plane, the humerus of M. olecranus could be elevated to a subhorizontal position and depressed to a subvertical position. It could move through the parasagittal plane from a subvertical position at full protraction to a position above the horizontal at full retraction. These results correct the previous mischaracterization of shoulder motion in M. olecranus as restricted to a small arc with the arms held in a permanent sprawl. The range of humeral motion in M. olecranus is much greater than that found by the previous method and allowed the animal to tuck its arms in at the sides, in addition to allowing them to sprawl so as to orient the palm downward. The wide range of humeral motion allowed M. olecranus to forage for insects by employing hook-and-pull digging at surfaces with a wider range of orientations than the previous study showed to be possible.

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 enforcing glenohumeral joint stability matter? A new rapid muscle redundancy solver highlights the importance of non-superficial shoulder muscles.

The complexity of the human shoulder girdle enables the large mobility of the upper extremity, but also introduces instability of the glenohumeral (GH) joint. Shoulder movements are generated by coordinating large superficial and deeper stabilizing muscles spanning numerous degrees-of-freedom. How shoulder muscles are coordinated to stabilize the movement of the GH joint remains widely unknown. Musculoskeletal simulations are powerful tools to gain insights into the actions of individual muscles and particularly of those that are difficult to measure. In this study, we analyze how enforcement of GH joint stability in a musculoskeletal model affects the estimates of individual muscle activity during shoulder movements. To estimate both muscle activity and GH stability from recorded shoulder movements, we developed a Rapid Muscle Redundancy (RMR) solver to include constraints on joint reaction forces (JRFs) from a musculoskeletal model. The RMR solver yields muscle activations and joint forces by minimizing the weighted sum of squared-activations, while matching experimental motion. We implemented three new features: first, computed muscle forces include active and passive fiber contributions; second, muscle activation rates are enforced to be physiological, and third, JRFs are efficiently formulated as linear functions of activations. Muscle activity from the RMR solver without GH stability was not different from the computed muscle control (CMC) algorithm and electromyography of superficial muscles. The efficiency of the solver enabled us to test over 3600 trials sampled within the uncertainty of the experimental movements to test the differences in muscle activity with and without GH joint stability enforced. We found that enforcing GH stability significantly increases the estimated activity of the rotator cuff muscles but not of most superficial muscles. Therefore, a comparison of shoulder model muscle activity to EMG measurements of superficial muscles alone is insufficient to validate the activity of rotator cuff muscles estimated from musculoskeletal models.

Subcutaneous Implantable Cardioverter-defibrillator in Preventing Ventricular Arrhythmia and Sudden Cardiac Death – A Single-center Experience

Abstract Introduction: Subcutaneous implantable cardioverter-defibrillator (S-ICD) differs from the transvenous ICD (TV-ICD) system in its extrathoracic and extravascular localization, eliminating the risks arising from vascular access and leading to fewer complications. The objective was to describe the functionality and postoperative complications associated with SICD implants in patients with cardiac dysfunctions. Methods: We enrolled six patients eligible for SICD due to either anterior wall myocardial infarction or left ventricular dysfunction, who reported to our tertiary cardiac care center from June 2020 to March 2022. Preprocedural evaluation for various cardiac parameters was carried out. The procedure was performed under antibiotic prophylaxis. Two incision techniques were used for the SICD placement. The primary and secondary endpoints for the cases were set to evaluate device-related complications and predictive outcomes, respectively. Results: Subcutaneous implantable defibrillator was placed in six male patients aged 36−51 years. The procedure demonstrated an efficient, reliable, and well-accepted modality in eliminating ventricular tachycardia, ventricular fibrillation, and sudden cardiac death. In addition, postoperative complications, such as device infection, pocket hematoma, blood transfusion, prolonged hospitalization, cardiac perforation or tamponade, lead repositioning, or inappropriate shocks, were not reported in the 2 years of follow-up. Conclusion: Subcutaneous implantable defibrillator promises to offer a suitable and safer option for TV-ICD, especially in young patients. It circumvents the need to enter the vasculature or cardiac chambers. As a result, fewer reported lead-related complications, better cosmetic appearance, and greater immediate postoperative comfort as it permits free shoulder movement.

Effect of Mobilization with Movement on Pain, Disability, and Range of Motion in Patients with Shoulder Pain and Movement Impairment: A Systematic Review and Meta-Analysis

Background: Shoulder pain is a disabling musculoskeletal disorder worldwide. Thus, it is important to identify interventions able to improve pain and disability. Objective: To investigate the effects of mobilization with movement (MWM) on pain, disability, and range of motion in patients with shoulder pain and movement impairment. Methods: A systematic search of different databases was performed. The systematic review protocol has been registered in PROSPERO (CRD42023404128). A random-effects model for meta-analysis was used to determine the mean difference (MD), standardized mean differences (SMD), and 95% confidence interval for the outcome of interest. Results: Twenty-six studies were included. Of these, eighteen were included in the meta-analysis. MWM improved pain during movement with a moderate effect SMD of (−0.6; 95% confidence interval, −1.1 to −0.1, I2 = 0%; N = 66;) and shoulder abduction MD of (12.7°; 1.3 to 24.0; I2 = 73%; N = 90) compared to sham MWM in the short term (0–6 weeks). Combined MWM and conventional rehabilitation improved pain at rest, with a MD of (−1.2; −2.2 to −0.2; I2 = 61%; N = 100), and disability SMD of (−1.3; confidence interval −2.2 to −0.4; I2 = 87%; N = 185) compared to conventional rehabilitation alone in the short term. Combined MWM and conventional rehabilitation also resulted in improvement in shoulder abduction and external rotation. Compared to Maitland, MWM resulted in improvement in the shoulder abduction MD (20.4°; confidence interval 4.3 to 36.5; I2 = 89%; N = 130) in the short term. There is no information regarding long-term effects. Conclusion: Evidence suggests that MWM may reduce shoulder pain and restore shoulder range of motion and function. Our findings are promising, but the evidence is not strong enough to recommend it pragmatically.

Technology-Assisted Upper Limb Therapy (TAULT): Evaluation of Clinical Practice at a Specialised Centre for Spinal Cord Injury in Switzerland

(1) Improving upper limb function is essential for people with tetraplegia. Although promising, technology-assisted upper limb training is understudied in this population. This article describes its implementation in a Swiss spinal cord injury rehabilitation centre and reports on the observed changes. (2) A retrospective evaluation of clinical data from January 2018 to June 2020 examined patient characteristics, training parameters, goal-setting practices, goal achievement, and changes in muscle strength over the course of technology-assisted upper limb training. (3) Data analysis included 61 individuals, 68.9% of whom had a spinal cord injury. The ArmeoSpring was the most frequently used device. The typical treatment regimen was three 25 min sessions per week, with evaluations approximately every six weeks. The 1:1 sessions, delivered by specialised staff, focused primarily on improving shoulder movement and the ability to eat and drink. Functional goals were set using a grid. Performance on selected goals in the areas of ‘body functions’ and ‘activities &amp; participation’ as well as muscle strength, increased over the course of training. (4) The ArmeoSpring has broad applicability. Despite the observed improvements, the isolated effect of technology-assisted upper limb training cannot be concluded due to the lack of a control group and various concurrent interventions.

Validity and Reliability of POM-Checker for Measuring Shoulder Range of Motion in Healthy Participants: A Pilot Single-Center Comparative Study.

The aim of this study was to compare shoulder movement measurements between a Kinect-based markerless ROM assessment device (POM-Checker) and a 3D motion capture analysis system (BTS SMART DX-400). This was a single-visit clinical trial designed to evaluate the validity and reliability of the POM-Checker. The primary outcome was to assess the equivalence between two measurement devices within the same set of participants, aiming to evaluate the validity of the POM-Checker compared to the gold standard device (3D Motion Analysis System). As this was a pilot study, six participants were included. The intraclass correlation coefficient (ICC) and the corresponding 95% confidence intervals (CIs) were used to assess the reproducibility of the measurements. Among the 18 movements analyzed, 16 exhibited ICC values of >0.75, indicating excellent reproducibility. The results showed that the POM-checker is reliable and validated to measure the range of motion of the shoulder joint.

Scapular stabilization exercise training improves treatment effectiveness on shoulder pain, scapular dyskinesis, muscle strength, and function in patients with subacromial pain syndrome: A randomized controlled trial

IntroductionSubacromial pain syndrome (SPS) is a common cause of shoulder pain, and is associated with functional limitation, workdays lost, disability, and poor quality of life. PurposeOur purpose was to investigate the effects of scapular stabilization exercises in patients with SPS. MethodSixty-four patients with SPS who also exhibit observable scapular dyskinesis defined by the scapular dyskinesis test were recruited and randomized to scapular stabilization exercise training group or to control group. All participants received the same rehabilitation protocol including glenohumeral and scapular mobilization, pendulum exercises, shoulder stretching, range of motion exercises, strengthening, and proprioceptive exercises. Patients in the scapular stabilization exercise training group performed additional scapular stabilization exercises. The presence of scapular dyskinesis, shoulder pain severity, motion, muscle strength, scapular upward rotation, and shoulder disability were assessed before and after the four-week rehabilitation program. ResultsThe scapular stabilization exercise training group had better improvement in scapular dyskinesis, pain, muscle strength, and shoulder disability compared to the control group (p < 0.05). However, there was no statistically significant time-group interaction regarding shoulder motion and scapular upward rotation (p > 0.05). ConclusionsScapular stabilization exercises added to the shoulder mobilization, stretching, and strengthening are effective in improving scapular dyskinesis, reducing pain, increasing muscle strength and shoulder function in patients with SPS accompanied by scapular dyskinesis.

The Median Effective Volume of 0.375% Ropivacaine for Ultrasound-guided Anterior Suprascapular Nerve Block in Arthroscopic Shoulder Surgery

BACKGROUND: The suprascapular nerve (SSN) is an important nerve that contributes to shoulder joint sensation and movement. The anterior suprascapular nerve block (aSSNB) has the potential for noninferior analgesic effect compared with the interscalene block while preserving respiratory function. This study investigated the median effective volume (MEV) of 0.375% ropivacaine in aSSNB for analgesic effect among patients undergoing arthroscopic shoulder surgery. OBJECTIVES: Our primary objective was the MEV. The secondary objectives included the 24 hour sufentanil consumption, 24 hour patient-controlled analgesia (PCA) presses, and incidences of diaphragm impairment. STUDY DESIGN: Prospective registered (ChiCTR2300070129), single-armed, volume-finding study. SETTING: This study was conducted in a tertiary, single center. METHODS: There were 23 patients who completed the study. Using an up-and-down process, patients enrolled in the study received different volumes of 0.375% ropivacaine for an aSSNB adjusted based on the success or failure of the previous patient in the study’s block by increasing or decreasing the volume by 3 mL. The first patient received 15 mL of 0.375% ropivacaine. The nerve blocks were evaluated by the sensory score of the C5 and C6 dermatomes. RESULTS: MEV50 (50% of the patients) was 6 mL (95% CI, 5.78 - 6.78 mL), and MEV95 (95% of the patients) was 13.88 mL (95% CI, 13.37 - 14.87 mL). There was no significant difference in the PCA presses, 24 hour sufentanil consumption, and incidences of diaphragm impairments between successful and unsuccessful blocks. LIMITATIONS: Our study focused on the analgesic effect rather than hemi-diaphragmatic paralysis with 0.375% ropivacaine for an aSSNB. The study also did not test varying ropivacaine concentrations while keeping the volume constant. Further investigation with varying concentrations and a larger sample size is indicated to address the optimal volume and concentration to balance analgesia and diaphragm function. CONCLUSIONS: To produce effective analgesic effect, the MEV50 is 6 mL, and the MEV95 is 13.88 mL in patients undergoing arthroscopic shoulder surgery who receive an aSSNB using 0.375% ropivacaine for analgesia. KEY WORDS: Anterior suprascapular nerve block, ultrasound-guided, median effective volume, dose finding, up and down procedure, postoperative analgesia, diaphragm movement, centered isotonic regression

The effects of walking aids on shoulder joint kinematics in older persons: an initial study

BackgroundMany older persons with degenerative physical functions use walking aids to improve their ambulation ability. The aim of this study was to investigate the effects of walking aids with different configurations on shoulder joint motion in older persons.MethodsThe 3D motion capture system VICON was applied to collect data on gait parameters and shoulder motion characteristics of 6 older persons walking either independently or with the assistance of a footed walking frame and a wheeled walking frame. The different effects of walking aids on gait parameters and the shoulder joint motion of older individuals were quantitatively analyzed.ResultsThe gait parameters of the older individuals changed significantly when they used walking frames to assist walking. Compared to independent walking, the range of motion of the shoulder joint was reduced by 79.92% in flexion when walking with a wheeled walking frame. Meanwhile, the range of motion in flexion, extension, and external rotation increased by 76.04%, 85.55%, and 110.99%, respectively, when walking with a footed walking frame.ConclusionThe motion characteristics of shoulder joints in older persons were significantly affected by using different walking aids. These changes in shoulder joint motion characteristics will lead to potential diseases related to the shoulder musculoskeletal system. These findings are beneficial to determine a walking aid for older people.

Outcomes of humeral osteotomies versus soft-tissue procedures in secondary surgical procedures for neonatal brachial plexus palsy: a meta-analysis.

Secondary surgical procedures can be used in brachial plexus birth injury to correct shoulder movement imbalances. This study compares outcomes of the two secondary surgical procedure types: humeral osteotomies and soft tissue procedures. Outcome measures assessed included active and passive internal and external rotation, active and passive abduction and adduction, active and passive flexion and extension, percentage of the humeral head anterior to the middle glenoid fossa, glenoid version, and Mallet Score. Nineteen full-text articles were included in the analysis. Humeral osteotomies resulted in a loss of internal rotation postoperatively (-15.94°). Active internal rotation was not evaluated for soft tissue procedures. All other assessed outcomes were improved postoperatively for bony and soft tissue procedures. Bony procedures exhibited a greater degree of active external rotation postoperatively when compared to soft tissue procedures (+67° vs. +40°). Both bony and soft tissue procedures Improve shoulder function in children with neonatal brachial plexus palsy, however, soft tissue procedures showed greater consistency in outcomes. Level of Evidence: IV.

Performance Evaluation of an Immersive Virtual Reality Application for Rehabilitation after Arthroscopic Rotator Cuff Repair.

Few studies have evaluated the effectiveness of shoulder rehabilitation in virtual environments. The objective of this study was to investigate the performance of a custom virtual reality application (VR app) with a stereophotogrammetric system considered the gold standard. A custom VR app was designed considering the recommended rehabilitation exercises following arthroscopic rotator cuff repair. Following the setting of the play space, the user's arm length, and height, five healthy volunteers performed four levels of rehabilitative exercises. Results for the first and second rounds of flexion and abduction displayed low total mean absolute error values and low numbers of unmet conditions. In internal and external rotation, the number of times conditions were not met was slightly higher; this was attributed to a lack of isolated shoulder movement. Data is promising, and volunteers were able to reach goal conditions more often than not. Despite positive results, more literature comparing VR applications with gold-standard clinical parameters is necessary. Nevertheless, results contribute to a body of literature that continues to encourage the application of VR to shoulder rehabilitation programs.

Reverse shoulder arthroplasty in obstetric brachial plexus injury: our experience with shoulder motion analysis

BackgroundObstetric brachial plexus injury (OBPI) is a weakening or paralysis of the upper arm caused by brachial plexus injury followed by a muscle paralysis with severe repercussions on the movement of the shoulder joint following a progressive glenohumeral joint deformity.This case series analyzes the clinical and radiological outcomes of reverse total shoulder arthroplasty (RSA) in OBPI patients with a follow-up of 2 years.Materials and methodsOBPI patients with secondary end-stage glenohumeral arthritis were enrolled in the study and they were treated with RSA. Patient demographics and clinical outcomes [Range of Motion (ROM), Visual Analog Scale (VAS), Oxford Shoulder Score (OSS)] were evaluated. A novel Shoulder motion analysis was carried out to investigate specific movement patterns of scapulothoracic movements in these patients. This study is a prospective cohort study.ResultsFour Patients (M: F = 1:3) were enrolled in the study, the mean age was 49.3 years (+ 2.75), the mean OSS (Oxford Shoulder Score) decreased from 48.8 (± 2.5) preoperatively to 18.30 (± 2.78), the mean VAS (Visual Analog Scale) decreased from 7.25 (± 0.5) to 1.7 (± 0.3) in the follow up (∆% relative pain reduction:− 76.5%), Shoulder ROM obtained an improvement (p < 0.05) except for abduction and external rotation. The average follow-up time was 26.3 months (+− 4.5). Shoulder motion analysis showed a complete loss of the scapular tilting above 90 degrees of flexion compared to the typical one of standard RSA with a pattern shifted towards scapular retraction (engaging trapezius and rhomboid muscles) to compensate the loss of the posterior tilting.ConclusionsRSA in OBPI patients demonstrated a significant improvement of pain symptoms and a moderate improvement in daily activities, anyway with a more appreciable quality of life over time even if the marked hypotrophy especially of the posterior shoulder muscles showed some limits in maintaining suspension of the upper limb and a minor external rotation, with an internal rotation attitude during the movements.Level of evidence: Level IV, Case series.

Integrating Artificial Intelligence for Improved Management of Frozen Shoulder and Complications in Breast Cancer Surgery: A Perspective from Thailand

Breast cancer is a leading cause of mortality among women worldwide, necessitating surgical interventions like lumpectomy, mastectomy, or modified radical mastectomy. However, these procedures often lead to postoperative complications, such as frozen shoulder, significantly impacting patients’s quality of life. This review focuses on the challenges associated with frozen shoulder and other complications following breast cancer surgery. It proposes the integration of Artificial Intelligence (AI) in assessment and intervention as a cost- effective solution. Frozen shoulder, also known as adhesive capsulitis, affects around 22.2% of breast cancer patients, particularly those undergoing axillary approaches. It is frequently accompanied by Axillary Web Syndrome (AWS) and Post-Mastectomy Pain Syndrome (PMPS), resulting in pain, limited range of motion, and compromised functional abilities. Conservative treatments, including exercises and rehabilitation programs, have shown positive outcomes in managing these symptoms. Previous studies have demonstrated the effectiveness of exercises, joint mobilization techniques, and home-based exercise programs in improving muscle strength, range of motion, and functional ability in breast cancer survivors. Abnormal neuromuscular control and kinematic distortions in shoulder and spinal movements have also been identified, highlighting the significance of neuromuscular training for shoulder joint complex recovery. The integration of AI in the assessment and intervention of frozen shoulder can offer cost-effective solutions and reduce waiting times at healthcare centers in Thailand. AI technologies can enable precise evaluations and personalized treatment plans, optimizing patient outcomes and resource utilization. In conclusion, physical therapy plays a crucial role in managing frozen shoulder and other complications following breast cancer surgery. Evidence-based practices, including comprehensive patient education, tailored exercise programs, manual therapy techniques, and pain management strategies, are essential for effective treatment. Integrating AI in assessment and intervention can further enhance outcomes and alleviate the burden on healthcare resources.