Shoulder Syndrome Research Articles

Radiotherapy for painful shoulder syndrome: aretrospective evaluation.

We evaluated the efficacy of low-dose radiotherapy for painful shoulder syndrome from an orthopedic perspective. Patients with painful shoulder syndrome were recruited for this retrospective clinical quality assessment from January 2011 to December 2017. Patients were treated with alinear accelerator or an orthovoltage device at individual doses of 0.5-1.0 Gy and total doses of 3.0-6.0 Gy. To assess response, we used the von Pannewitz score with five levels: "worsened," "unaffected," "improved," "significantly improved," and "symptom free." "Good treatment success" was defined as "significantly improved" and "symptom free." Within-group and between-group differences were statistically evaluated. Of 236 recruited patients (150 women, 86men; mean age66.3 [range 31-96] years), 180 patients underwent radiotherapy with alinear accelerator and 56with an orthovoltage device. Fractionation was 12 × 0.5 Gy in 120 patients, 6 × 0.5 Gy in 74, and 6 × 1 Gy in 42patients. Treatments were completed in one series for 223 and in two series at least 6weeks apart for 13patients. Of the 236 patients, 163 patients (69.1%) agreed to be re-interviewed at amedian of 10.5 (range 4-60) months after radiotherapy completion. Directly after radiotherapy, 30.9% (73patients) had "good treatment success," which had increased to 55.2% (90patients) at follow-up. Protracted pain improvement with low-dose radiotherapy is possible in painful shoulder syndrome. Patients with refractory pain because of subacromial syndrome or shoulder osteoarthritis should also be evaluated for radiotherapy.

Comparison of the Effects of Volar-Assisted and Elastic Wrist Splints on Edema, Pain, Grip Strength, and Functionality in Pregnant Women With Carpal Tunnel Syndrome.

Carpal tunnel syndrome (CTS) is a common musculoskeletal problem in pregnancy. The aim of this study is to compare the effects of rigid and elastic wrist splints on edema, pain levels, grip strength, and upper-extremity functionality in pregnant women with CTS. Forty-one pregnant women in the last trimester of pregnancy who were diagnosed with CTS were included in the study. The grip strength was evaluated with the Jamar hand dynamometer, functionality with the Quick Disabilities of the Arm, Shoulder, and Hand and Boston Carpal Tunnel Syndrome Questionnaire, pain with the Visual Analog Scale (VAS), and edema with the water overflow method. The mean age of the participants was 31.71 ± 5.78 years, body mass index was 28.85 ± 3.63 kg/m2, duration of pain was 2.24 ± 0.79 months, and their pain intensity was 6.63 ± 1.69 according to the VAS. As a result of the study, reductions in pain (P = .001), increases in functionality values (P = .001), increases in grip strength (P = .001), and decreases in edema (P = .001) were observed in both groups after the treatment. However, there was no significant difference in pain, functionality, or grip strength values between the groups after the treatment (P > .05). In this study comparing the effects of a wrist splint to those of an elastic splint, both treatment methods for pregnant women with CTS decreased pain and edema, increased grip strength, and improved upper-extremity functionality. Considering individual needs, characteristics, and living conditions, both splints can be recommended for pregnant women with CTS.

What Happens to Youth Baseball Players Diagnosed With Little League Shoulder and Little League Elbow Syndrome?

The long-term prognosis of baseball and softball players diagnosed with Little League elbow (LLE) and Little League shoulder (LLS) is unknown. Many of these athletes are potentially at risk of developing future shoulder and elbow injuries that may require surgical intervention. This study's purpose is to retrospectively assess 5-year patient-reported outcomes and career progression of a series of youth baseball and softball players diagnosed with LLE and LLS. This institutional review board-approved, single-center, retrospective study evaluated 5-year outcomes of a cohort of youth baseball and softball players diagnosed with LLE and LLS between 2013 and 2017. Demographic and clinical data was recorded including age, gender, primary position, and months played per year. A standardized phone survey was obtained approximately 5 years post-treatment to assess upper extremity function, career progression, and pain recurrence. Sixty-one patients (44 LLE, 17 LLS) met the inclusion criteria and participated in a standardized phone survey. The mean age at the time of diagnosis was 13.2 years and all but one of the athletes were male. On average, about 80% (34/44 LLE, 15/17 LLS) played baseball 9 months or more per year. After diagnosis and nonoperative management, more than 80% (37/44 LLE, 14/17 LLS) were able to return to competition, but up to 40% of players changed positions (9/44 LLE, 7/17 LLS). Five years later, less than half (21/44 LLE, 8/17 LLS) were playing baseball actively. The recurrence rate was >20% (9/42 LLE, 6/17 LLS) with a mean time of recurrence of 8.8 months. Patients who experienced symptom recurrence were less likely to play baseball 5 years later and had lower patient-reported outcomes. A diagnosis of LLE and LLS in early adolescence can be a setback for a young athlete. Fortunately, most athletes will be able to return to competition with ∼50% still competing at 5 years. Very few will progress to future arm surgery, but recurrence rates are relatively high, and these athletes are less likely to participate in their sport 5 years later. Level IV-Retrospective cohort study.

A case report of ansa cervicalis to spinal accessory transposition graft: A new surgical technique to prevent shoulder dysfunction

Introduction and Importance: The spinal accessory nerve is at risk when performing neck dissections for head and neck cancers. Injury to this nerve can result in shoulder syndrome, which can be challenging to manage. Various nerve repair or grafting methods are available to prevent this condition. A safe, simple, and cost-effective option is the ansa cervicalis to spinal accessory transposition graft. Case Presentation: A 60-year-old Afro-Trinidadian female presented to the Outpatient clinic for evaluation of a scalp lesion and a large neck mass for a duration of one year. Preoperative tissue biopsies confirmed she had squamous cell cancer with metastatic spread to the cervical nodes. The patient underwent surgical excision of the scalp lesion and a left neck dissection with the sacrifice of the sternocleidomastoid and the left spinal accessory nerve due to tumour involvement. During the procedure, the ansa cervicalis was successfully joined to the distal remainder of the spinal accessory nerve. After the surgery, the patient fully recovered and achieved a good quality of life during the 24 months follow-up. Clinical Discussion: This is the first reported case of using the ansa cervicalis to reinnervate the trapezius muscle through the spinal accessory nerve. This procedure aims to prevent pain, muscle wasting, and adhesive capsulitis. A quality-of-life questionnaire and adequate range of motion proved the success of this procedure, demonstrating that this option provides practical, functional, and aesthetic benefits for patients. Conclusion The ansa cervicalis to spinal accessory transposition nerve graft is a valuable option for reinnervation. This case report highlights the effectiveness of this single-stage procedure in preventing shoulder syndrome. Keywords

Comparison of the rounded shoulder, kyphosis postures, and glenohumeral range of motion in patients with primary and secondary frozen shoulder

BackgroundFrozen shoulder syndrome is a common pathological condition of the shoulder characterized by pain, capsular stiffness, and limited movement of the glenohumeral joint. Shoulder joint problems can be related to the posture of the shoulder girdle and position of the scapula. This study aimed to compare the rounded shoulder and kyphotic posture and shoulder range of motion in patients with primary and secondary frozen shoulders. MethodsFifty-five female patients with frozen shoulder, diagnosed by a physician, were divided into primary (n = 25) and secondary (n = 30) groups. Photography and Kinovea software were used to measure the rounded shoulder angle, a flexible ruler for the kyphosis angle, and a universal goniometer for shoulder range of motion. For data analysis, we utilized SPSS software. In order to compare the groups, independent t-test was used at a significance level of 0.05. ResultsThe results showed that the rounded shoulder (p = 0.001) and kyphosis (p = 0.002) angles were significantly greater in the primary group compared to the secondary group. There was no significant difference between the two groups for flexion (p = 0.874), abduction (p = 0.786), extension (p = 0.331), and internal rotation (p = 0.128) range of motion. However the external rotation range of motion in the primary group was significantly less (p = 0.028) compared to the secondary group. ConclusionsPeople with primary frozen shoulder are more likely to experience postural problems in the shoulder girdle and have a limited range of motion for external rotation compared to those with secondary frozen shoulder.

SHORT-TERM OUTCOMES OF HOME-BASED AND OUTPATIENT PROGRAMS OF PHYSICAL THERAPY IN PATIENTS WITH FROZEN SHOULDER AND MYOFASCIAL PAIN SYNDROME

The aim: is to compare short-term results of home-based and outpatient programs of physical therapy among patients with frozen shoulder and concomitant thoracic myofascial pain syndrome.
 Materials and methods. The study involved 80 patients. The range of motion in the shoulder joint affected by capsulitis was assessed. A numerical pain scale was used to assess pain sensations when pressing on trigger points. Functional limitations in the shoulder were measured by means of the Oxford Shoulder Score (before and 1.5 months after the end of the physical therapy). Participants were divided into two groups: home-based group (HG) and outpatient group (ОG). All the patients were consulted by a physical therapist. ОG patients received end-range mobilization with the assistance of a physical therapist 5 times a week to improve shoulder joint mobility. Most of ОG participants received 15 procedures (3 weeks). Patients HG performed therapeutic exercises without any assistance at home. (twice a day, 3 weeks). In terms of trigger points therapy, the patients performed ischemic compression without any assistance.
 Results. Patients of both groups demonstrated positive dynamics of the studied indicators. Comparison of the short-term results of the therapy according to range of motion and pain showed better indicators in the ОG. Comparison of the initial results of the groups in Oxford Shoulder Score items did not reveal any significant differences. Total score was 18.2±6.5 points in ОG and 17.6±7.5 points in HG (p=0.715). Me (25%; 75%) values were 17.5 (12.5; 23.8) and 18 (13; 23.5) points, respectively. Comparison of the final results of the groups in Oxford Shoulder Score items revealed significant differences. Total score was 47 (47; 48) points in ОG and 33 (31; 35.75) points in HG (p<0.001). x̅±SD values were 46.5±2.6 and 32.8±4.4 points, respectively.
 Conclusions. Short-term results of the outpatient program in terms of pain indicators, mobility of the shoulder joint and functional limitations were better as compared to the home-based program of physical therapy in patients with frozen shoulder and concomitant thoracic myofascial pain syndrome.

A new perspective of frozen shoulder pathology; the interplay between the brain and the immune system.

Frozen shoulder (FS), also known as adhesive capsulitis of the shoulder (FS), is a fibrotic inflammatory process of unknown etiology whose main symptoms are pain, stiffness and the loss of joint mobility. These symptoms may be associated with pathologies such as diabetes, Dupuytren's syndrome and the prevalence of today's sedentary lifestyle. This literature review provides an overview of the epidemiology and pathogenesis of this pathology, as well as the mechanisms of lowgrade chronic inflammation and infection, insulin resistance, and omics-science associated with it. We also propose a new hypothesis related to the possibility that the GABAergic system could play a decisive role in the development of frozen shoulder and that therefore diabetes type 1, endocrinological autoimmune disorders and frozen shoulder are connected by the same pathophysiological mechanisms. If that is true, the combined presence of psycho-emotional stress factors and pathogenic immune challenges could be the main causes of frozen shoulder syndrome. Finally, we propose a series of possible intervention strategies based on a multifactorial etiological and mechanistic concept.

Study of the Anatomical Variations of Spinal Accessory Nerve Seen During Neck Dissection.

In our study, thirty one neck dissections in thirty patients were performed as a part of their treatment for head and neck cancers over a period of one year. In this study, we aimed to report anatomical variations of the spinal accessory nerve (SAN) encountered during neck dissection with respect to important reference points and structures in the neck and correlate them with the length of the neck and height of patient. We preserved SAN in all the neck dissections and studied its course and branching in relation to internal jugular vein (IJV), sternocleidomastoid (SCM) muscle, greater auricular point (GAP), mastoid process, clavicle, angle of mandible, length of the neck and height of the patient. In 67.7% patients, the SAN was ventral to the IJV at the level of posterior belly of digastric muscle and in 32.3%, it was dorsal to the vein. In all the cases, SAN was found cephalic to the GAP at the posterior border of the SCM musclewith a mean distance of 1.72 ± 0.54cm (range 0.90-3.06cm). The distance between the tip of mastoid process and the point of emergence of the SAN from the posterior border of SCM (Exit Point length) was found to be nearly constant with a mean of 6.35 ± 0.63cm (range 5.03-8.13cm). We also found that there is a positive correlation between various parameters and the length of the neck and height of patients. Distance of exit point of SAN from the clavicle, however, is least helpful. We infer that the GAP is one of the most reliable landmarks for the localization of the SAN, followed by distance of exit point from mastoid process and angle of mandible. Also, surgeon should be aware of the variations regarding relationship to internal jugular vein and branching pattern of the nerve. The exit point should be sought for relatively inferiorly in longer necks and taller patients. SAN has great variations and thorough knowledge of these helps to prevent debilitating sequelae and medicolegal repercussions of shoulder syndrome.

Clinical evaluation of a patient participation assessment system for upper extremity rehabilitation exercises.

In conventional and robotic rehabilitation, the patient's active participation in exercises is essential for the maximum functional output to be received from therapy. In rehabilitation exercises performed with robotic devices, the difficulty levels of therapy tasks and the device assistance are adjusted based on the patient's therapy performance to improve active participation. However, the existing therapy performance evaluation methods are based on either some specific device designs or certain therapy tasks, which limits their widespread use. In this paper, the effectiveness of a participation assessment system, which can evaluate patients' therapy performance, tiredness, and slacking independent of any device design and therapy exercise, was clinically tested on ten patients diagnosed with frozen shoulder syndrome. The patients performed exercises using the system once a week throughout their 4-week treatment period. Multiple clinical measurements and scales were employed during the clinical study to assess patients' progress and status, such as tiredness throughout the therapy process. The clinical data, along with the patient findings obtained from the participation assessment system, were statistically analyzed and compared. The findings revealed that the patients' improvements and progress during the therapy process clinically coincide with the variations in the performance evaluation results of the system, and the implemented method successfully assesses the patients' participation during the rehabilitation exercises.

Genetic causal association between frozen shoulder and carpal tunnel syndrome: a two-sample mendelian randomization

ObjectiveObservational studies have suggested an association between frozen shoulder (FS) and carpal tunnel syndrome (CTS). However, due to challenges in establishing a temporal sequence, the causal relationship between these two conditions remains elusive. This study, based on aggregated data from large-scale population-wide genome-wide association studies (GWAS), investigates the genetic causality between FS and CTS.MethodsInitially, a series of quality control measures were employed to select single nucleotide polymorphisms (SNPs) closely associated with the exposure factors. Two-sample Mendelian randomization (MR) was utilized to examine the genetic causality between FS and CTS, employing methods including Inverse-Variance Weighted (IVW), MR-Egger, Weighted Median, Simple Mode, and Weighted Mode approaches. Subsequently, sensitivity analyses were conducted to assess the robustness of the MR analysis results.ResultsIVW analysis results indicate a positive causal relationship between CTS and FS (p < 0.05, OR > 1), while a negative causal relationship between the two conditions was not observed. Heterogeneity tests suggest minimal heterogeneity in our IVW analysis results (p > 0.05). Multivariable MR testing also indicates no pleiotropy in our IVW analysis (p > 0.05), and stepwise exclusion tests demonstrate the reliability and stability of the MR analysis results. Gene Ontology (GO) pathway analysis reveals enrichment of genes regulated by the associated SNPs in the TGFβ-related pathways.ConclusionThis study provides evidence of the genetic causal association between frozen shoulder and carpal tunnel syndrome and provides new insights into the genetics of fibrotic disorders.

Sensory innervation of the human shoulder joints in healthy and in chronic pain shoulder syndromes

BackgroundAfferent innervation of shoulder joints plays a fundamental role in nociception and mechanoception and its alteration result in shoulder´s disease that course with pain and functional disability. MethodsJoints shoulder from healthy subjects (n = 20) and with chronic pain shoulder syndromes (n = 17) were analyzed using immunohistochemistry for S100 protein to identify nerve structures (nerve fibers and sensory corpuscles), coupled with a quantification of the sensory formations. Sensory nerve formations were quantified in 13 distinct areas in healthy joint shoulder and in the available equivalent areas in the pathological joints. Statistical analyses were conducted to assess differences between healthy shoulder and pathological shoulder joint (p< 0.05). ResultsAll analyzed structures, i.e., glenohumeral capsule, acromioclavicular capsule, the extraarticular structures (subcoracoid region and subacromio-subdeltoid bursa) and intraarticular structures (biceps brachii tendon and labrum articulare) are variably innervated except the extrinsic coracoacromial ligament, which was aneural. The afferent innervation of healthy human shoulder joints consists of free nerve endings, simple lamellar corpuscles and Ruffini’s corpuscles. Occasionally, Golgi-Mazzoni’s and Pacinian corpuscles were found. However, the relative density of each one varied among joints and/or the different zones within the same joint. As a rule, the upper half and anterior half of healthy glenohumeral capsules have a higher innervation compared to the lower and posterior respectably. On the other hand, in joints from subjects suffering chronic shoulder pain, a reduced innervation was found, involving more the corpuscles than free nerve endings. ConclusionsOur findings report a global innervation map of the human shoulder joints, especially the glenohumeral one, and this knowledge might be of interest for arthroscopic surgeons allowing to develop more selective and unhurt treatments, controlling the pain, and avoiding the loss of afferent innervation after surgical procedures. To the light of our results the postero-inferior glenohumeral capsular region seems to be the more adequate to be a surgical portal (surgical access area) to prevent nerve lesions.

Effectiveness of Physiotherapy Methods in Medical Rehabilitation of Patients with Shoulder and Scapular Pain Syndrome in a Sanatorium: a Randomized Clinical Study

INTRODUCTION. The high prevalence of shoulder pain syndrome (SPS) determines the relevance of the development of new comprehensive methods of rehabilitation of this category of patients.&#x0D; AIM. To evaluate the clinical effectiveness of shockwave therapy (SWT) and pulsed low-frequency electrostatic field (PLEF) in patients with SPS undergoing medical rehabilitation in a sanatorium-resort organization in comparison with traditional health resort treatment.&#x0D; MATERIALS AND METHODS. The comparative analysis of medical rehabilitation efficiency was carried out in 90 patients with SPS aged 31–68 years undergoing medical rehabilitation in the health resort complex “Vulan” — a clinical branch of National Medical Research Center for Rehabilitation and Balneology. All patients were divided into 3 groups of 30 persons each by the method of simple randomization. Group 1 patients (control) received traditional health resort treatment, including ozokeritotherapy, physical exercise therapy, electrotherapy with sinusoidal modulated currents and manual massage. Patients of the second group (comparison) received against the background of the above complex 3 SWT procedures on the shoulder joint once a week. Group 3 patients (main group) received, in addition to traditional treatments, 3 SWT and 8 field PLEF treatments administered every other day. The effectiveness of rehabilitation was evaluated according to the severity of pain syndrome (VAS scale), Swanson’s scale for the shoulder. Movement volume before and after rehabilitation was measured with an orthopedic angle gauge. Microcirculation state was assessed by laser Doppler flowmetry (LDF). Leukert scale was used to assess the state of well-being. The results of the study were assessed 18 days after the beginning of rehabil itation measures.&#x0D; RESULTS AND DISCUSSION. Patients who additionally received SWT and PLEF against the background of traditional health resort treatment noted a significant reduction in the severity of pain syndrome, while in the main group pain regression was noted earlier (on day 4–5), whereas in the comparison group the same results were obtained by the day 14th . In the control group, patients noted significant changes on the VAS scale only by the end of the rehabilitation course. On the Swanson scale, the most significant positive results were also obtained by the patients in the main group: the pain decreased on average 2.6-fold, the volume of active movements in the shoulder joint increased 2.7-fold, and activity in everyday life 1.9-fold. Statistical differences in the Swanson Scale scores with the comparison group were obtained with regard to pain syndrome and volume of active movements. When comparing with the control group, reliable differences were revealed in all Swanson’s scale indicators in both the main group and the comparison group. When studying the dynamics of microcirculation according to LDF data, it was noted that reliable changes in the main indices of the LDF-gram were revealed only in the groups that received innovative physical therapy interventions.&#x0D; CONCLUSION. Thus, the inclusion of modern physiotherapeutic techniques of SWT and PLEF into the program of health resort treatment of patients with SPS allows to increase significantly the efficiency of medical rehabilitation carried out in the sanatorium organization.

Cranio-Caudal Identification and Preservation of Spinal Accessory Nerve during Modified Radical Neck Dissection

Introduction: The spinal accessory nerve (SAN) is encountered during neck dissection surgeries and is at the highest risk for iatrogenic injury, which may lead to shoulder syndrome. This functional deformity can be avoided by preservation of SAN in modified radical neck dissection (MRND). Description: Many techniques are described in the literature for SAN preservation, one of which is the identification of Erb’s point and dissection in the posterior triangle where the SAN leaves the sternocleidomastoid (SCM) muscle. However, this technique for identification and preservation of SAN requires a skilled and trained surgeon to avoid any iatrogenic injury to SAN. Conclusion: Therefore, a study was carried out on 30 patients to find if the cranio-caudal dissection of SAN helps in the preservation of the nerve during MRND surgeries at the beginner’s level.

Study and experimental analysis of the effect of static stretching combined with resistance training on neck and shoulder syndrome in college students in the context of big data

Abstract In order to explore the effect of variable resistance training with edge computing and information physical system model combined with computer vision under static traction in neck and shoulder rehabilitation training of college students. In this paper, 90 cases of neck and shoulder patients admitted to XX Hospital from February 2022 to December 2022 with neck and shoulder syndrome in a university in Shanghai, were selected as study subjects and randomly divided into 45 cases of the observation group and 45 cases of the control group. Edge computing and physical information system were used for data processing, and patients in the observation group received variable resistance training combined with static traction, and patients in the control group received static traction. The results showed that after rehabilitation training, the effective rates of the observation group and the control group were 91.11% and 71.11%, respectively, and the differences between the groups were statistically significant (P&lt;0.05). Comparing the visual analog scale (VAS) and neck disability index (NDI) of the two groups, the VAS score of the observation group was lower than that of the control group after treatment (P&lt;0.05), and the NDI score of the observation group was lower than that of the control group (P&lt;0.05). It indicates that the use of static stretching and resistance training for neck and shoulder syndrome in college students is more effective in relieving patients’ neck pain and is worthy of clinical promotion and application.

Shoulder function after neck dissection with level IIb preservation: a prospective observational study

Background Shoulder syndrome can be reduced by preserving the spinal accessory nerve (SAN). However, it is unclear whether performing level IIb preservation will decrease the risk of SAN injury and shoulder syndrome. Aims/objectives We investigated whether neck dissection with level IIb preservation can reduce shoulder dysfunction and postoperative quality of life (QOL) in head and neck cancer patients. Material and methods This prospective observational study enrolled patients who underwent neck dissection from 2011 to 2014. Patients were divided into three groups (level IIb preservation group [group 1], IIb dissection group [group 2], and IIb and V dissection group [group 3]). Postoperative shoulder function and QOL were evaluated among the three groups. Results There were a total of 35 neck sides in three groups, with nine neck sides in group 1, 16 neck sides in group 2, and 10 neck sides in group 3. Although the results showed less shoulder dysfunction in group 1 at early postoperative period. The QOL in group 1 was preserved in the early postoperative period. Conclusions and significance Neck dissection with level IIb preservation may help reduce shoulder syndrome and maintain QOL in the early postoperative period.

Bone and Rheumatic Disorders in Diabetes

Diabetes mellitus, a chronic metabolic ailment characterized by hyperglycemia, affects millions of people worldwide and poses a considerable burden on public health. While the number-one headache of diabetes frequently involves the cardiovascular, renal, and neurological systems, increasing evidence indicates a link between diabetes and bone and rheumatic issues. This abstract explores the complex interplay between diabetes and musculoskeletal conditions, to offer an overview of their pathophysiological mechanisms and medical implications. Bone problems in diabetes are typically characterized by decreased bone mineral density (BMD) and an increased risk of fractures. The imbalance between bone formation and resorption, driven by hyperglycemia-precipitated oxidative stress, advanced glycation stop products (ages), and persistent inflammation, results in decreased osteoblasts interest and more desirable osteoclast features. Furthermore, alterations in the insulin signaling pathway and impaired osteocyte characteristics contribute to compromised bone formation in diabetes. These adjustments together contribute to an extended fracture chance and not on-time fracture recuperation in patients with diabetes. Rheumatic issues in diabetes embody a wide variety of conditions including osteoarthritis, rheumatoid arthritis, and frozen shoulder syndrome. Persistent irritation due to dysregulated immune responses in diabetes can boost joint degeneration, worsen pain, and cause useful impairments. Furthermore, weight problems, regularly linked to type 2 diabetes, place additional mechanical pressure on the weight-bearing joints, exacerbating the progression of osteoarthritis. Rheumatoid arthritis, an autoimmune disease, may have complex interactions with diabetes because of its shared inflammatory pathways. The clinical implications of these interactions are significant. First, healthcare providers should be vigilant in screening and diagnosing bone issues in patients with diabetes, particularly in the elderly population who are at a higher risk of fractures. Second, promoting lifestyle changes, including weight management, normal physical activity, and glycemic manipulation, can mitigate bone and joint-associated complications in diabetes. Additionally, progressive treatment plans focused on the common pathways of inflammation and oxidative stress may hold promise for the treatment of diabetes and its musculoskeletal comorbidities. Bone and rheumatic disorders are increasingly identified as vital comorbidities in diabetes. The tricky pathophysiological mechanisms involved call for similar research to expand patient-centered therapeutic techniques that efficiently manage these musculoskeletal headaches and enhance the overall quality of life of individuals living with diabetes. A complete understanding of these relationships will enable healthcare specialists to enforce timely interventions and customize treatment plans to deal with the specific demanding situations posed by the aid of bone and rheumatic disorders in patients with diabetes.

Wide-awake local anesthesia no tourniquet and dexamethasone (WALANT-D) for modified Camitz opponens plasty in severe carpal tunnel syndrome-a retrospective study of 30 cases

BackgroundTo analyze the outcome of modified Camitz opponens plasty using the wide-awake local anesthesia no tourniquet with dexamethasone (WALANT-D) technique in severe carpal tunnel syndrome (CTS). MethodsA retrospective review was performed in 30 hands of 27 patients who underwent Camitz opponens plasty for severe CTS between 2019 and 2021. All patients had 8 mg of dexamethasone mixed with WALANT. Preoperative active palmar abduction, grip strength, side, and pulp pinch strength, Kapandji score, and electrophysiological assessment of compound muscle action potential (CMAP) for abductor pollicis brevis (APB) were compared with the postoperative values. The palmaris longus had dual insertion into the abductor pollicis brevis and extensor expansion. The time interval of post-operative pain-free was noted. The Disabilities of the Arm, Shoulder, and Hand (DASH) and Carpal Tunnel Syndrome instrument (CTSI) also assessed the functional outcome. ResultsThe mean age of patients was 35 years (range 32–58 years). There were five male and 22 female patients. Of the female patients, three females had severe bilateral CTS. Twenty right and ten left hands were affected. The mean follow-up of our study was 12.5 months (range 10–14 months). The patients were pain-free for an average of 19.5 h postoperatively. There was a significant improvement in the thumb palmar abduction, grip strength, side, and pulp pinch strength, DASH score, CTSI, and APB-CMAP (p < 0.05) at the final follow-up. ConclusionsModified Camitz opponens plasty with a dual insertion into APB and extensor expansion effectively improves thumb opposition and daily activities. The tendon tensioning, checking the pulley impingement, appreciation of active movements, and a comfortable patient operative experience are advantages of the WALANT. Adding dexamethasone as an adjuvant to WALANT prolongs the analgesia and duration of the nerve block. Level of evidenceIV, Retrospective case study.

Association Between Subscapularis Trigger Point and Frozen Shoulder: A Cross Sectional Study

Background: Uncertainty surrounds the relationship between subscapularis trigger sites and the development of frozen shoulder syndrome. Objectives: The purpose of this study was to investigate the relationship between subscapularis trigger points and immobilized shoulder in patients from the Outpatient Physical Therapy Department at NMC Hyderabad. Methods: This cross-sectional study was conducted from September 2022 to February 2023 and included 71 patients diagnosed with grade 1 or 2 frozen shoulder based on Codman's criteria and aged 35 or older. Using an axillary approach, subscapularis trigger points were identified manually, and their presence was evaluated on both the affected and unaffected sides. Using the Chi-square test in SPSS version 22, the relationship between subscapularis trigger points and immobilized shoulder was analyzed. Results: 33 (46.5%) of the 71 participants were male, while 38 (53.5%) were female, with a mean age of 53.32 years. On the affected side, there was a significant association between frozen shoulder and subscapularis trigger points (p =.001). Intriguingly, a statistically significant difference was also observed in the unaffected shoulder joint (p =.001). Practical Implications: It highlighted the importance of diagnosing and treating subscapularis trigger points in patients with frozen shoulder, potentially guiding new therapeutic strategies to improve shoulder mobility and reduce pain in these individuals. Conclusion: Our findings indicate a considerable association between subscapularis triggers points and frozen shoulder, making these trigger points possible therapeutic targets. To investigate the underlying mechanisms and validate these results in larger populationss, additional research is required. Keywords: Frozen shoulder syndrome; Orthopedics; Subscapularis trigger points; Surgery

Level II lateral neck dissection for papillary thyroid carcinoma: A retrospective cohort study

BackgroundFor N1b papillary thyroid carcinoma (PTC) patients, lateral neck dissection encompassing levels Ⅱ-Ⅴ is generally recommended. However, routine level Ⅱ dissection is controversial given the low incidence of metastasis, and potential complications such as increased shoulder syndrome. MethodsRetrospective analysis of consecutive patients with papillary thyroid carcinoma who underwent lateral neck dissection at a single institution from January 2019 to April 2021 was performed. Clinicopathological features such as age, gender, tumor location, tumor size, TgAb and TPOAb levels, capsular invasion, multifocality and lymph node metastases were examined to evaluate the occurrence of metastatic Level Ⅱ lymph nodes. ResultsOverall and occult level Ⅱ metastases were observed in 51.83% and 34.84% of cN1b PTC patients. Multivariant analysis showed that primary tumor, location of primary tumor and positive level Ⅴ can serve as independent risk factors of metastasis in level Ⅱ. For cN1b PTC patients not suspected of level Ⅱ lymph nodes preoperatively, independent risk factors for predicting occult level Ⅱ metastases may include the location of primary tumor, positive level Ⅲ and positive level Ⅴ. ConclusionA significant number of patients with PTC and lateral neck disease experienced Level Ⅱ metastasis, with the location of primary tumor and multilevel lymph node involvement being the independent risk factors. If the tumor is less than 1 cm and located at lower 2/3 lobe, there is minimal possibility of level Ⅱ lymph node metastasis.

키네지오 테이핑 적용이 둥근어깨증후군 대상자의 폐활량에 미치는 영향

The purpose of this study was to find out the effect of kinesio taping on vital capacity of subjects with rounded shoulder syndrome. 26 of 20s men and women in their with round shoulder syndrome were randomly assigned to an experimental and a control group. All subjects measured their vital capacity before starting the experiment, and rested for an hour. The experimental group applied kinesio taping while resting, and the control group did not take any intervention. After an hour, subjects were measured vital capacity again to compare the amount of change. The experimental group showed significant changes in FVC, FEV1, and PEF after an hour. In the control group, there were no significant changes in vital capacity. In comparison between groups, the experimental group showed significant differences in FVC, FEV1, and PEF compared to the control group. Kinesio taping is effective in improving vital capacity for subjects who have rounded shoulder syndrome.