Significant Improvement In Shoulder Function Research Articles

A Comparison of Open-Construct PEEK Suture Anchor and Non-Vented Biocomposite Suture Anchor in Arthroscopic Rotator Cuff Repair: A Prospective Randomized Clinical Trial

To compare radiologic bone ingrowth and the clinical outcomes of an open-construct (PEEK) (polyether ether ketone) suture anchor with those of a non-vented biocomposite suture anchor in patients with arthroscopic rotator cuff repair. Sixty-nine patients were randomly allocated into 2 groups based on type of suture anchors used for rotator cuff repair; group 1: open-construct PEEK anchor (36 patients), group 2: non-vented biocomposite anchor (33 patients). The status of bone ingrowth into the anchor and the presence of cyst formation were evaluated at 6 months postoperatively by computed tomography scan using the Modified Barber's ossification scale. The American Shoulder and Elbow Surgeons score, Constant score, and visual analog scale score for pain and range of motion were evaluated. Magnetic resonance imaging or ultrasonography was performed at 12 months postoperatively to examine the integrity of the repaired rotator cuff tendon. Significant improvements in shoulder function and pain relief were observed regardless of the anchor used (both Group 1 and 2; P < .001). No differences were found in functional scores and range of motion between the 2 groups. Group 1 showed better bone ingrowth grades than group 2 (poor 2.8 vs 24.2%, fair 27.8 vs 39.4%, good 38.9 vs 33.3%, and excellent 30.6 vs 3.0%; P < .001). The rate of cyst formation around the anchor on the 6 months' postoperative computed tomography (group 1: 14% and group 2: 12%) and re-tear rate at 12 months (5% each) showed no difference between the 2 groups. Shoulder function was improved after complete rotator cuff repair and similar clinical outcomes were achieved regardless of suture anchor material and shape. However, the open-construct PEEK anchor provided better bone ingrowth into the anchor than the non-vented biocomposite anchor at 6 months after arthroscopic rotator cuff repair. Level I; Prospective Randomized Trial.

9–13 Year Results of Stemless Humeral Head Replacement. A Prospective Study

The aim of the study was the evaluation of long-term results of shoulder arthroplasty using a stemless humeral head component. Since their introduction in 2005, the stemless humeral head prostheses have been established. Long-term functional and radiological results are not available until now. Since 2005 we documented stemless humeral head replacement prospectively. Eighty-seven patients with a mean age of 58 years at surgery (40 hemi-shoulder arthroplasties (HSA),47 total shoulder arthroplasties (TSA),46 female, 41 male) were clinically and radiologically followed-up after a mean of 128 months (range, 105-157 months).Functional results were documented using the age- and gender-normalized Constant score (rel. CS). The rel. CS improved significantly (p<0.0001) from 56 points (p) pre-op to 88p post-op. Its subcategories pain (8p pre-, 12p post-OP; p<0.0001), ADL (10p pre-OP, 15p post-OP; p<0.0001), ROM (20p pre-OP, 28p post-OP; p<0.0001) and strength (6p pre-OP, 11p post-OP; p=0.001) improved significantly as well. Results for HSA (mean follow-up 128 months):-Rel CS:57p pre-OP,90p post-OP; p<0.0001-CS pain:7.8p pre-OP,11.9p post-OP; p<0.0001-CS ADL:9.5p pre-OP,14.5p post-OP; p=0.001-CS ROM:19.8p pre-OP,27.5p post-OP; p=0.001-CS strength:6p pre-OP,12.2p post-OP; p=0.01 Results for TSA (mean follow-up 128 months):-Rel CS:55p pre-OP,87p post-OP; p=0.001-CS pain:7.9p pre-OP,12.4p post-OP; p=0.003-CS ADL:10.4p pre-OP,14.8p post-OP; p=0.014-CS ROM:19.5p pre-OP,28.9p post-OP; p=0.001-CS strength:6.1p pre-OP,9.8p post-OP; p=0.033 There is no significant (p>0.05) difference of pre- and post-op CS as well as its subcategories between HSA and TSA. Radiologically we observed no loosening of the stemless humeral head component. An incomplete radiolucent line of the humeral component was found in 7.9%.Stress shielding around the humeral component was not detected. Upward migration of the humeral head was observed in 23% (23.7% HSA, 15% TSA; p=0.334).No implant failure was observed at the humeral side. One humeral head replacement was explanted 7 months post-op because of early infection. 18.4% had a rotator-cuff deficiency at follow-up (HSA: 7.5%,TSA 27.7%;p=0.039).Overall,12.6% of stemless shoulder arthroplasties were revised to reverse total shoulder arthroplasty (5% of HSA,19.1% of TSA).8.5% of TSA required an anatomic glenoid replacement. TSA had significantly (p=0.014) more frequently revision surgery than HSA. Stemless humeral head replacement showed no loosening with a significant improvement of shoulder function after a mean of 11 years. There is no difference of functional results between HSA and TSA.TSA showed a significant higher revision rate than HSA.

CLINICAL OUTCOME OF ARTHROSCOPIC ROTATOR CUFF REPAIR IN PATIENTS 2 AGED 70 YEARS AND OLDER

Aim: The purpose of this study was to evaluate the outcome of arthroscopic rotator cuff 13 repair in patients aged 70 years or older and report our results in terms of pain, range of 14 motion, muscle strength, and functional outcome. 15 Materials and Methods: We performed retrospective data review and identified 97 16 shoulders (94 patients) of our interest with minimum 24 months of follow-up. All patients 17 were evaluated with Visual Analogue Scale (VAS), Range of motion (ROM), Manual 18 Muscle Strength, and Oxford Shoulder Score (OSS) preoperatively and at final follow-up. 19 Patient satisfaction was determined by asking patients whether they were satisfied (yes 20 or no). Statistical analysis was performed using paired t test to compare pre and 21 postoperative measures and Mann-Whitney U test to see the effect of age and gender on 22 the final outcome. 23 Results: Of 97 shoulders, 70 (67.9%) shoulders were available for final evaluation with 24 a mean age of 73.56 years (70 to 81) and mean follow-up of 57.52 months (24 to 122). 25 Mean VAS for pain was improved from 8.4 (6 to 10) to 1.04 (0 to 5) (P < 0.001) at final 26 follow-up. Mean forward flexion, abduction, external rotation increased from 112.50o to 27 165.43o (P < 0.001), 114.36o to 166.86o (P < 0.001), 45.14o to 73.64o (P <0.001) 28 respectively, as well as, Internal rotation also improved in 55 patients (78.5%, n = 70) at 29 final follow-up. Mean muscle strength of Supraspinatus (SSP) and Infraspinatus (ISP) 30 according to MRC scale was significantly improved (P < 0.05) from 2.84 (2 to 4) to 4.67 31 (4 to 5) and from 2.77 (2 to 4) to 4.64 (3 to 5) at the final follow-up respectively. Mean 32 OSS was improved from 11.49 to 44.40 (P < 0.001) and only three patients (4.28%, n = 33 70) were subjectively less than satisfied at final follow-up. 34 Conclusions: There was a significant improvement in shoulder function with a low 35 complication rate. Hence, we have no hesitation to recommend repair in this age group. 36 Provided the rotator cuff is not grossly wasted, and patient is fit to undergo surgery, age 37 should not be the criteria for determining repairability.

Novel and effective arthroscopic extracapsular stabilization technique for anterior shoulder instability-BLS.

Arthroscopic Bankart repair for the treatment of anterior shoulder instability is associated with a high rate of recurrent instability. Extracapsular stabilization of the glenohumeral joint with enhancement of anterior wall soft tissues may be an effective alternative treatment technique. The aim of this study is to retrospectively assess clinical outcomes in the treatment of anterior shoulder instability using a novel technique of anterior extracapsular stabilization-"between glenohumeral ligaments and subscapularis tendon" (BLS). Patients with anterior shoulder instability who underwent surgical treatment with a novel arthroscopic BLS technique between 2008 and 2016 were eligible for inclusion. According to the level of glenoid bone loss, patients were separated into four groups. Group 1 comprised patients with GBL equal to or less than 5%, group 2 patients with GBL 6-10%, group 3 patients with GBL 11-15%, and group 4 patients with GBL > 15%. A positive outcome in this study was defined as full restoration of joint stability. To evaluate clinical results, preoperative range of ER and IR measured in 90 degrees of abduction were compared with ER and IR measured at final follow-up. Additional outcome instruments used consisted of the Constant Score and the Walch-Duplay Score. A total of 150 patients underwent arthroscopic BLS surgery. During the study period, 50 patients were lost to follow-up and 100 patients were available for final analysis. Mean patient age was 27.5 (± 10.3) years at the time of surgery. Mean duration of follow-up was 82.9 (± 29.4) months. At final assessment, 86 patients (86%) were categorized as having a positive outcome, with full restoration of joint stability. Recurrence of shoulder instability was observed in 14 (14%) patients, including 6 (6%) cases that were associated with major trauma. At final follow-up, the mean Constant Score was 88.2 ± 10.1, compared to 82.9 ± 9.1 preoperatively (p < 0.05). The mean final and mean preoperative Walch-Duplay Scores were 81.5 ± 18.9 and 52.2 ± 11.9, respectively (p < 0.05). There was no statistically significant limitation of external or internal rotation. The BLS technique has been shown to be an effective method to anterior shoulder instability in patients without significant glenoid bone loss. It was shown that this technique provides significant improvement in shoulder function without reducing shoulder range of motion. IV.

The efficacy of mirror therapy in patients with adhesive capsulitis: A randomized, prospective, controlled study

To investigate the effect of mirror therapy (MT) in conjunction with a standard physical therapy program on shoulder range of motion (ROM), pain and quality of life in patients with adhesive capsulitis (AC). This prospective, randomized, controlled, single blind study included 30 patients with AC who were scheduled to undergo 10 sessions of standard physical therapy. The participants were divided into two identical groups, namely, The MT group and the control group. After each session, the MT group underwent active ROM exercises with the reflective side of the mirror while the control group underwent active ROM exercises with the non-reflective side of the mirror. Pre-treatment and post-treatment shoulder pain (VAS), shoulder function (UCLA shoulder scale) and quality of life (SF-36) were assessed, and active and passive ROM were quantified with a goniometer. Both groups revealed a significant reduction of shoulder pain and significant improvement of shoulder function, active and passive ROM, and quality of life after the treatment. Post-treatment measurements showed that the MT group had a significantly lower amount of pain compared to the control group (p= 0.007). The UCLA scores were significantly higher in the MT group (p= 0.003). The MT group had significantly better post-treatment active flexion, active abduction, passive flexion, and passive abduction values (p= 0.001, p= 0.02, p= 0.002, and p= 0.02, respectively). The MT group had significant post-treatment improvement in physical function, physical role limitation and emotional role limitation, and pain parameters including SF-36 (p= 0.003, p= 0.01, p= 0.015, and p= 0.002, respectively). MT in conjunction with physical therapy appears to be an effective treatment modality that reduces shoulder pain and improves shoulder ROM, shoulder function, and quality of life among patients with AC.

Quantitative analysis of shoulder function and strength after breast reconstruction: A retrospective cohort study.

Immediate breast reconstruction (IBR) after mastectomy has been proven to affect patient quality of life, psychological well-being, and functional capacities. In the present study, we aimed to investigate the effect of breast reconstruction on postoperative shoulder function and muscle performance by evaluating isokinetic muscle performance tests.A retrospective chart review to collect data on shoulder function analysis with isokinetic muscle performance testing was performed among patients who received mastectomy with IBR from July 2013 to March 2015. Patients were categorized into 4 groups: a control group that underwent mastectomy without reconstruction, a tissue expander/implant insertion group, a pedicled latissimus dorsi (LD) flap group, and a free transverse rectus abdominis muscle (TRAM) flap group.Analysis of the groups at 1 to 3, 4 to 6, 7 to 9, 10 to 12, and 13 to 15 months postoperatively showed significant shoulder function improvement in the tissue expander/implant and TRAM groups as measured by linear regression analysis. Compared with the control group, patients who received immediate reconstruction with tissue expander/implant insertion or a TRAM flap showed statistically significant improvement in shoulder function after mastectomy.IBR with a TRAM flap or tissue expander/implant insertion were more beneficial for shoulder rehabilitation and for regaining function compared to mastectomy alone and breast reconstruction with a LD flap.

Convertible Glenoid Components Facilitate Revisions to Reverse Shoulder Arthroplasty Easier: Retrospective Review of 13 Cases.

Removal of a cemented glenoid component often leads to massive glenoid bone loss, which makes it difficult to implant a new glenoid baseplate. The purpose of this study was to demonstrate the feasibility of revisions with a completely convertible system and to report clinical and radiographic results of a retrospective review of 13 cases. Between 2003 and 2011, 104 primary total shoulder arthroplasties (TSAs) were performed with an uncemented glenoid component in our group. Of these patients, 13 (average age, 64 years) were revised to reverse shoulder arthroplasty (RSA) using a modular convertible platform system and were included in this study. Average follow-up after revision was 22 months. Outcome measures included pain, range of motion, Constant-Murley scores, Simple Shoulder Tests, and subjective shoulder values. Active flexion increased significantly from a mean of 93° (range, 30°-120°) to 138° (range, 95°-170°) (P = 0.021), and active external rotation increased significantly from 8° (range, -20°-15°) to 25° (range, -10°-60°). Mean pain scores significantly improved from 4.2 to 13.3 points. The mean Constant Scores improved from 21 (range, 18-32) to 63 (range, 43-90). Subjectively, 12 patients rated their shoulder as better or much better than preoperatively. This retrospective study shows that a complete convertible system facilitates conversion of TSAs to RSAs with excellent pain relief and a significant improvement in shoulder function.

Arthroscopic Subacromial Spacer Implantation in Patients With Massive Irreparable Rotator Cuff Tears: Clinical and Radiographic Results of 39 Retrospectives Cases

To evaluate the clinical and radiographic outcome of a biodegradable subacromial spacer in the treatment of massive irreparable rotator cuff tear. Between January 2011 and December 2014, all shoulders with symptomatic massive irreparable rotator cuff tears treated at our institution with arthroscopic implantation of a biodegradable subacromial spacer followed for at least 1year were included in our series. Patients with osteoarthritis ≥ grade 3 in the Hamada classification were excluded. Outcome measures included pre- and postoperative, range of motion, Constant score, acromiohumeral distance, and Hamada classification on anteroposterior and lateral radiographs. Thirty-nine consecutive shoulders (37 patients) met the inclusion criteria. The mean age of patients was 69.8 (53-84) years. At the last follow-up (mean 32.8 ± 12.4months), range of motion was significantly increased for all patients in anterior elevation (from 130° to 160°, P= .02), abduction (from 100° to 160°, P= .01), and external rotation (from 30° to 45°, P=.0001). The mean Constant score was also significantly (P < .001) improved from 44.8 (±15.2) preoperatively to 76.0 (±17.1) at the last follow-up. The mean acromiohumeral distance significantly (P= .002) decreased from 8.2mm (±3.4) to 6.2mm (±3.1) at the last follow-up. The Hamada score progressed of 1 radiographic stage in 4 shoulders (15%) and progressed of 3 stages in 2 (4%), whereas the other 32 shoulders remained stable. No intra- or postoperative complications were found except for 1 patient who required a revision for spacer migration. Arthroscopic implantation of a subacromial spacer for irreparable rotator cuff tear leads to significant improvement in shoulder function at a minimum of 1year postoperatively. Level IV, therapeutic case series; treatment study.

Functional outcome of arthroscopic subacromial decompression in primary shoulder impingement syndrome due to extrinsic mechanical causes

Background: The purpose of this study was to determine the role of arthroscopic subacromial decompression in primary shoulder impingement due to secondary mechanical causes in terms of functional outcome. Materials and Methods: Patients undergoing arthroscopic subacromial decompression at JSS Medical College, Mysore between September 2014 and May 2016 were studied prospectively. A total of 20 patients diagnosed with primary shoulder impingement meeting the required criteria were included in the study. The patients were put on a 6 week course of physiotherapy as initial trial with non-operative treatment. None of the patients responded to this treatment and persisted to have symptoms. These patients were treated surgically with arthroscopic subacromial decompression. The University of California Los Angeles (UCLA) shoulder rating scale was used to assess shoulder function. Assessment was done at pre-operative, 4 weeks, 8 weeks, 12 weeks, 6 months, 9 months and 12 months post arthroscopic subacromial decompression. Results: Patients had statistically significant improvement in shoulder function after arthroscopic sub acromial decompression (p

Effect of corticosteroid injections versus physiotherapy on pain, shoulder range of motion and shoulder function in patients with subacromial impingement syndrome: A systematic review and meta-analysis.

BackgroundSubacromial impingement syndrome (SIS) is one of the most common causes of shoulder pain. Limited research has been conducted into the efficacy of corticosteroid injections (CSIs) compared to physiotherapy in the management of SIS.ObjectiveTo critically appraise and establish the best available evidence for the effectiveness of CSI in comparison with physiotherapy for the management of pain, shoulder range of motion (ROM) and shoulder function in patients with SIS.MethodologySeven databases were searched from inception to February 2016, namely PubMed, Science Direct, EBSCO Host: SPORTDiscus, EBSCO Host: CINAHL, Cochrane, Scopus and PEDro. The main search terms were shoulder impingement syndrome and/or subacromial impingement syndrome, corticosteroid injections and/or steroid injections, physical therapy and/or physiotherapy. Only randomised controlled trials (RCTs) were considered for inclusion. The articles were appraised according to the PEDro scale. The Revman© Review Manager Software was used to combine the results of shoulder function and the data were illustrated in forest plots.ResultsThe PEDro scores of the three RCTs that qualified for this review ranged from 7 to 8/10. There is Level II evidence suggesting that besides a significant improvement in shoulder function in favour of CSI at 6–7 weeks follow-up (p < 0.0001), no evidence was found for the superiority of CSIs compared with physiotherapy for pain, ROM and shoulder function in the short- (1–3 months), mid- (6 months) and long term (12 months).ConclusionIn patients with SIS only a short term significant improvement in shoulder function was found in favour of CSIs.

Humeral Head Arthroplasty and Meniscal Allograft Resurfacing of the Glenoid

The two to five-year results of humeral head arthroplasty and lateral meniscal allograft resurfacing of the glenoid in patients fifty-five years of age or younger were previously reported by the senior author (M.A.W.). The purpose of the present study was to report the survival rate, clinical findings, and radiographic results of the original thirty shoulders (thirty patients) followed for a mean duration of 8.3 years (range, five to twelve years). The scores on the visual analog scale for pain, American Shoulder and Elbow Surgeons scoring system, and Simple Shoulder Test were significantly improved at the latest follow-up evaluation compared with the preoperative findings (p < 0.001). Radiographic indices of posterior subluxation did not significantly increase from the immediate postoperative imaging to the latest radiographs, while the glenohumeral joint space demonstrated a gradual decrease. Nine (30%) of thirty shoulders were known to have undergone a reoperation. The present study demonstrated that biological glenoid resurfacing combined with hemiarthroplasty can provide significant improvement in shoulder function and pain relief in young patients with glenohumeral arthritis; however, mid-term follow-up at a mean of over eight years demonstrated a high reoperation rate.

Clinical outcomes after arthroscopic release for recalcitrant frozen shoulder.

To explain the role of arthroscopic release in intractable frozen shoulders. We used different questionnaires and measuring tools to understand whether arthroscopic release is the superior modality to treat patients with intractable frozen shoulders. Between 2007 and 2013, in a prospective study, we enrolled 80 patients (52 females and 28 males) with recalcitrant frozen shoulder, who underwent arthroscopic release at Ghaem Hospital, a tertiary referral center, in Mashhad, Iran. Before operation, all patients filled out the Disability of Arm, Shoulder and Hand (DASH), Constant, University of California Los Angeles (UCLA), ROWE and Visual Analogue Scale (VAS) for pain questionnaires. We measured the difference in range of motion between both the normal and the frozen shoulders in each patient. The average age of the patients was 50.8±7.1 years. In 49 patients, the right shoulder was affected and in the remaining 31 the left side was affected. Before surgery, the patients were suffering from this disease on average for 11.7±10.3 months. The average time to follow-up was 47.2±6.8 months (14 to 60 months). Diabetes mellitus (38%) and history of shoulder trauma (23%) were the most common comorbidities in our patients. We did not find any significant differences between baseline characteristics of diabetics patients with non-diabetics ones. After surgery, the average time to achieve maximum pain improvement and range of motion were 3.6±2.1 and 3.6±2 months, respectively. The VAS score, constant shoulder score, Rowe score, UCLA shoulder score, and DASH score showed significant improvement in shoulder function after surgery, and shoulder range of motion improved in all directions compared to pre-operation range of motion. According to our results, arthroscopic release of recalcitrant frozen shoulder is a valuable modality in treating this disease. This method could decrease pain and improve both subjective and objective mid-term outcomes.

Efficacy of proprioceptive neuromuscular facilitation on shoulder function in secondary shoulder impingement

Objective: To determine the efficacy of proprioceptive neuromuscular facilitation (PNF) on shoulder function in participants with secondary shoulder impingement. Background: Previous research has established a relationship between shoulder muscle weakness and causation of secondary shoulder impingement. Recent evidence has shown that proprioceptive neuromuscular facilitation was effective in relieving pain and increasing overhead reach. However, none of the studies have measured shoulder function after PNF application. Methods: This study used a pretest–posttest experimental group design. Thirty participants (15 male and 15 female) with a diagnosis of secondary shoulder impingement were recruited from a hospital setting and divided into two groups. Group 1 received both PNF and the conventional protocol while group 2 received only the conventional protocol. Both groups received the intervention for a period of 3 weeks. Shoulder Pain And Disability Index (SPADI) score and overhead reach were analysed in both groups. Results: Group 1 showed significant improvement over Group 2 in terms of SPADI score and overhead reach. The experimental group showed significant improvement in (reduction of) SPADI score over the control group (23.8 ± 4.9) at a significance level of P&lt;0.0001. The experimental group showed a significant difference over the control group for overhead reach (3.63 ± 1.8) at a significance level of P&lt;0.03. Conclusion: The addition of PNF to conventional treatment brings significant improvement in shoulder function in comparison to conventional treatment alone in participants with secondary shoulder impingement. PNF helps in early recovery.

Clinician's Commentary on Singh et al.

Should physiotherapy be considered a standard of care for women with breast cancer (and other types of cancer)? The pilot project presented by Singh and colleagues1 describes the role of physiotherapists starting before breast-cancer surgery and a follow-up process that may result in less arm morbidity. While the purpose of a pilot project is to test feasibility, test a study process, or establish sample size for a larger study,2 Singh and colleagues have also identified benefits for early intervention by physiotherapists for women with breast cancer.1 These preliminary findings are supported in previous research by Springer and colleagues that found significant improvements in shoulder function;3 however, while this study was prospective in design, it had no control group.3 Beurskens and colleagues4 have also reported beneficial effects of physiotherapy with postoperative intervention, but no preoperative intervention was included in their study. Other randomized controlled studies have found that early physiotherapy intervention was effective in reducing pain,5 an important post-surgery impairment reported by women with breast cancer, and in improving shoulder function with early or late treatment.6 But physiotherapy treatment is not limited to pain, shoulder function, and mobility in people with cancer. Regardless of when physiotherapists see patients with cancer—before surgery, immediately after surgery, or in a private clinic after recovery—exercise is the foundation of physiotherapy. Providing properly prescribed exercise for people with cancer has many benefits that are well described in the literature.7,8 There is evidence of the benefits of exercise and physiotherapy intervention throughout the cancer-care continuum, including palliative care.9–11 While physiotherapists focus on mobility and quality of life, it is important to remember that physiotherapy interventions can also affect survival: there is evidence that exercise can improve survival, reduce recurrence, and reduce overall mortality in women with breast cancer who exercise after diagnosis.12–15 The potential role of physiotherapists following breast-cancer surgery is summarized by the Norwegian Physiotherapists Association Standard on management of female breast cancer.16 Clinical guidelines on rehabilitation for women with breast cancer have been published, but their quality varies.17 As holistic care providers, physiotherapists can manage not only the physical challenges related to the cancer and its treatment but also other potential comorbidities and psychological effects associated with a cancer diagnosis. Following breast-cancer diagnosis and treatment, women often experience body-image changes and worry about their future or their families. During physiotherapy treatment, the therapist may be able to spend time with the patient and identify—and hopefully address—these non-physical problems. When a physiotherapist ask a patient, “How are you feeling today?” he or she is evaluating the patient's mental state16 and is ready to modify the planned physical treatment to include emotional support if necessary. Physiotherapists can also refer patients to other care providers when they no longer need specialized care. Given the evidence supporting physiotherapy interventions for women with breast cancer and the unique holistic skills available to physiotherapists, a referral to physiotherapy should routinely be considered when a woman is diagnosed with cancer. Although the role of physiotherapists may be educational before medical management is initiated, education empowers patients at a time when they feel vulnerable. As the cancer survivor moves through the cancer-care continuum, physiotherapists can work with other care providers to ensure access to evidence-based rehabilitation and/or exercise programmes. It is time to consider that physiotherapy should be a standard of care for people living with cancer.

Miniopen coracohumeral ligament release and manipulation for idiopathic frozen shoulder.

In the management of idiopathic frozen shoulder, manipulation under anaesthesia is known to have serious potential complications including fractures and intra-articular injuries. Arthroscopy is a safer treatment modality but requires special instruments, experience, and involves added cost. The aim of this work was to study the use of miniopen Coracohumeral ligament release and manipulation of the shoulder as a safe and simple method of treating idiopathic frozen shoulder that could be performed as a quick procedure under short duration anaesthesia obtaining a significant improvement of shoulder function while avoiding complications that are feared to occur with the use of manipulation under anaesthesia. Miniopen Coracohumeral ligament release is performed through a 3-cm incision. The Coracohumeral ligament is divided, and then the shoulder is manipulated without undue force. A case series including fifteen patients (19 shoulders) with idiopathic frozen shoulder operated by this technique is described. Miniopen Coracohumeral ligament release and manipulation is a quick procedure that may be performed under short duration anaesthesia obtaining a significant improvement of shoulder function meanwhile avoiding complications that are feared to occur with the use of manipulation under anaesthesia.

Single-Row Repair Versus Double-Row Repair of Full-Thickness Rotator Cuff Tears

The purpose of this meta-analysis was to assess whether there are differences in the outcomes between single-row and double-row rotator cuff repair. Using MEDLINE, SCOPUS, SCIRUS, CINAHL, and the Cochrane Library, as well as a hand search, we searched for articles comparing single-row and double-row rotator cuff repair that were published before September 2009. The controlled clinical studies that met the inclusion and exclusion criteria were assessed for quality of methodology. Two of the authors performed this review and assessment. Any disagreements were resolved by the third author. Three randomized controlled studies and two controlled clinical cohort studies were included in this meta-analysis. These studies were assessed as having a moderate to high level of evidence. The results showed that double-row repair improved tendon healing and provided greater external rotation but with significantly increased operative time. Furthermore, this study found that double-row repair decreased the recurrence rate. However, there were no statistically significant differences found in shoulder function as assessed by Constant score; American Shoulder and Elbow Surgeons (ASES) score; University of California, Los Angeles (UCLA) score; Western Ontario Rotator Cuff (WORC) index; Disabilities of the Arm, Shoulder and Hand (DASH) score; muscle strength; forward flexion; internal rotation; patient satisfaction; return to work; and adverse events. Despite the fact that double-row repair shows a significantly higher rate of tendon healing and greater external rotation than does single-row repair, there is no significant improvement in shoulder function, muscle strength, forward flexion, internal rotation, patient satisfaction, or return to work. Level II, meta-analysis of Level I and Level II studies.

Arthroscopic Capsular Release: A Prospective Double-Blind Randomized Study Comparing Two Types of Rehabilitation Regime. A Pilot Study

Background The aim of this study was to evaluate, prospectively, outcomes following arthroscopic capsular release on patients with a clinical diagnosis of frozen shoulder, comparing immediate mobilization (IM) vs immediate mobilization plus external rotation splintage at night for 10 nights (IM+EXT). Methods Patients with a clinical diagnosis of non-traumatic frozen shoulder seen in a single unit from May 2005 to December 2006 were considered for inclusion. Patients were assessed using the Constant score, Oxford shoulder questionnaire, and a visual analogue scale for pain (VAS pain). Patients were randomized to have immediate mobilization (IM) or immediate mobilization plus external rotation splintage at night for 10 nights (IM+EXT). Results Thirty patients were included and both groups showed significant improvement in all scores. Mean length of follow-up was 17 months. There was early (4 weeks post-operatively) significant improvement in shoulder function in both groups. The rehabilitation regime used did not affect the overall outcome. Conclusions Arthroscopic capsular release produces early symptom improvement in primary frozen shoulder. The use of an external rotation splint at night does not appear to improve outcome over simple early mobilization.

The accuracy of subacromial corticosteroid injections: A comparison of multiple methods

Corticosteroids are commonly used in the treatment of the impingement syndrome. Efficacy, as well as accurate placement, have been questioned. The purpose of this prospective, randomized study is to assess the accuracy of subacromial injections and to correlate accuracy with short term clinical outcome at 3 months. Sixty shoulders, which were diagnosed with impingement syndrome, were randomized to receive a subacromial injection of corticosteroids, local anesthetic, and contrast dye from 1 of 3 locations: anterolateral, lateral, or posterior. Accuracy was confirmed by 3 radiographic views of the shoulder, while clinical ratings were assessed by the UCLA shoulder score and a 10-point visual pain analog scale during the initial, post-injection, and 3-month visits. The overall accuracy was 70%, with no difference among the 3 portals. Accuracy was not related to body mass index. Furthermore, accurate injections did not significantly improve the UCLA score, pain scale, or patient satisfaction at 3 months. In contrast, accurate injections produced a positive Neer's impingement test more often (35/39 vs 9/16; P = .009). Overall, there was an improvement in the UCLA score (26.2-32.2; P < .001) and a decrease in the pain scale (7.2-3.43; P < .001) at 3-month follow-up. In conclusion, the accuracy of injection was 70%. Clinical improvement did not correlate with accuracy; however, accuracy did reliably produce a positive impingement test. This multimodal treatment plan did produce significant improvement in shoulder function and pain level in the short term.

The subacromial impingement syndrome of the shoulder treated by conventional physiotherapy, self-training, and a shoulder brace: Results of a prospective, randomized study

This prospective, randomized trial was performed to compare the results of treating subacromial impingement syndrome of the shoulder by a guided self-training program with the treatment by conventional physiotherapy or a functional brace. Sixty patients with the diagnosis of an outlet impingement syndrome of the shoulder (Neer I and II) were treated either by strengthening the depressors of the humeral head with a guided self-training program, by conventional physiotherapy, or by wearing a functional brace. The Constant-Murley score was assessed after 6 and 12 weeks. Shoulder pain was monitored with a visual analog scale. All three groups showed a significant improvement in shoulder function as well as a significant reduction in pain. There were no statistically significant differences among the groups. Guided self-training can lead to results similar to those of conventional physiotherapy. The comparable effect of the functional brace remains unclear and might be explained by an influence on proprioception.

The Use of Freeze-dried Allografts in the Management of Global Rotator Cuff Tears

Massive or global tears of the rotator cuff with loss of tendon substance and retracted cuff remnants pose a challenging surgical and rehabilitation problem. In seven patients, global cuff tears were reconstructed with freeze-dried rotator cuff allografts. Five of the seven patients had other significant debilitating medical problems. Three patients had received four steroid injections, one patient had six injections, and the remaining three patients had two injections in or about the affected shoulder. Five of the seven patients had their pain relieved. Only two patients had significant improvement in shoulder function after anterior acromioplasty and allografts. Freeze-dried rotator cuff allografts do not appear to be of significant value in the surgical management of chronic massive rotator cuff tears.