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Sports Medicine - Open Jan 2021Wave surfing will debut in the next Olympic Games and is increasingly popular as a sport. Chronic shoulder complaints are frequently reported amongst surfers, though...
BACKGROUND
Wave surfing will debut in the next Olympic Games and is increasingly popular as a sport. Chronic shoulder complaints are frequently reported amongst surfers, though literature researching its pathophysiology and prevention is scarce. This article provides an overview of the current literature, proposes a potential pathogenesis and a potential physiotherapeutic prevention program for surf-induced shoulder complaints.
METHODS
A systematic review was performed considering the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for articles regarding kinematic analysis of the surf paddling movement. Data sources were Embase, MEDLINE (PubMed) and Research gate. We included case series and cohort studies that originally studied or described the paddle movement made by wave surfers, studies that reported on kinesiologic analysis with nerve conduction studies and studies on 3D motion analysis of the shoulder while paddling.
RESULTS
Eight original articles were included that analysed the shoulder movement in paddling surfers. Muscles that are active during paddling are mainly internal rotators and muscles that are involved in shoulder flexion. Internal rotators are active in propelling the surfer through the water, though external rotator strength is only used while the arm is out of the water.
DISCUSSION
In surfers with shoulder complaints, external rotation range of motion and external rotation strength are impaired. Scapulothoracic dyskinesis may occur and subacromial pain syndrome may coincide. Further research should address potential pectoralis minor shortening, which may lead to aberrant scapular tilt and lateral rotation of the scapula. The surfer's shoulder is characterised by external rotation deficit, as opposed to internal rotation deficit in the thrower's shoulder, and it differs substantially from shoulder complaints in swimmers. Therefore, a specific prevention or rehabilitation protocol for surfers is required. Decreased thoracic extension may thereby alter the risk of scapular dyskinesis and hence increase the risk of impingement around the shoulder joint. A potential physiotherapeutic prevention programme should address all these aspects, with the main goal being to increase external rotator strength and to stretch the internal rotators.
CONCLUSION
There is a high incidence of chronic surf-induced shoulder complaints in surfers. Symptoms may arise due to imbalanced training or scapular dyskinesis, which may subsequently trigger subacromial pain. Physiotherapeutic prevention should include stretching of the internal rotators, external rotator training and optimisation of thoracic extension and scapulothoracic movement.
PubMed: 33409808
DOI: 10.1186/s40798-020-00289-0 -
Physical Therapy in Sport : Official... Nov 2019Shortness of the pectoralis minor (PM) is a potential mechanism underlying shoulder impingement syndrome. Few studies have examined the effects of kinesiotaping and... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Shortness of the pectoralis minor (PM) is a potential mechanism underlying shoulder impingement syndrome. Few studies have examined the effects of kinesiotaping and stretching exercise on PM length or index. This systematic review and network meta-analysis investigated the effects of stretching exercise and kinesiotaping on PM length and index in adults.
METHODS
This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomised controlled trials including adults with or without symptomatic shoulders were included. Heterogeneity between studies was assessed using I2 statistics, and publication bias was evaluated by constructing a funnel plot.
RESULTS
We extracted data from six randomised controlled trials that included 263 participants (age range: 18-50 years). Compared with usual care, kinesiotaping resulted in greater improvement in PM length (mean difference, 1.15 cm; 95% confidence interval [CI]: 0.20-2.10 cm). Compared with usual care and kinesiotaping, proprioceptive neuromuscular facilitation (PNF) stretching increased PMI significantly, with a mean difference of 1.40 (95% CI: 1.17-1.63) and 1.08 (95% CI: 0.29-1.87) cm, respectively.
CONCLUSION
Compared with no intervention, kinesiotaping is beneficial for lengthening the PM. Intervention with static stretching alone has no effect on PM length. Compared with kinesiotaping alone and no intervention, PNF stretching increases PMI.
Topics: Athletic Tape; Humans; Muscle Stretching Exercises; Network Meta-Analysis; Pectoralis Muscles; Randomized Controlled Trials as Topic; Shoulder
PubMed: 31442850
DOI: 10.1016/j.ptsp.2019.08.003 -
Anaesthesia Mar 2021The erector spinae plane block is a new regional anaesthesia technique that provides truncal anaesthesia for breast surgery. This systematic review and meta-analysis was... (Meta-Analysis)
Meta-Analysis
The erector spinae plane block is a new regional anaesthesia technique that provides truncal anaesthesia for breast surgery. This systematic review and meta-analysis was undertaken to determine if the erector spinae plane block is effective at reducing pain scores and opioid consumption after breast surgery. This study also evaluated the outcomes of erector spinae plane blocks compared with other regional blocks. PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov were searched. We included randomised controlled trials reporting the use of the erector spinae plane block in adult breast surgery. Risk of bias was assessed with the revised Cochrane risk-of-bias tool. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was used to assess trial quality. Thirteen randomised controlled trials (861 patients; 418 erector spinae plane block, 215 no blocks, 228 other blocks) were included. Erector spinae plane block reduced postoperative pain compared with no block: at 0-2 hours (mean difference (95% CI) -1.63 (-2.97 to -0.29), 6 studies, 329 patients, high-quality evidence, I = 98%, p = 0.02); at 6 hours (mean difference (95% CI) -0.90 (-1.49 to -0.30), 5 studies, 250 patients, high-quality evidence, I = 91%, p = 0.003); at 12 hours (mean difference (95% CI) -0.46 (-0.67 to -0.25), 5 studies, 250 patients, high-quality evidence, I = 58%, p < 0.0001); and at 24 hours (mean difference (95% CI) -0.50 (-0.70 to -0.30), 6 studies, 329 patients, high-quality evidence, I = 76%, p < 0.00001). Compared with no block, erector spinae plane block also showed significantly lower postoperative oral morphine equivalent requirements (mean difference (95% CI) -21.55mg (-32.57 to -10.52), 7 studies, 429 patients, high-quality evidence, I = 99%, p = 0.0001). Separate analysis of studies comparing erector spinae plane block with pectoralis nerve block and paravertebral block showed that its analgesic efficacy was inferior to pectoralis nerve block and similar to paravertebral block. The incidence of pneumothorax was 2.6% in the paravertebral block group; there were no reports of complications of the other blocks. This review has shown that the erector spinae plane block is more effective at reducing postoperative opioid consumption and pain scores up to 24 hours compared with general anaesthesia alone. However, it was inferior to the pectoralis nerve block and its efficacy was similar to paravertebral block. Further evidence, preferably from properly blinded trials, is required to confirm these findings.
Topics: Adult; Analgesia; Breast; Female; Humans; Nerve Block; Pain, Postoperative; Paraspinal Muscles; Treatment Outcome
PubMed: 32609389
DOI: 10.1111/anae.15164 -
European Journal of Surgical Oncology :... Sep 2019The safety of prepectoral breast reconstruction (PBR) after mastectomies as compared to subpectoral breast reconstruction (SBR) were unclear, so we conducted a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The safety of prepectoral breast reconstruction (PBR) after mastectomies as compared to subpectoral breast reconstruction (SBR) were unclear, so we conducted a systematic review to analyze their differences.
METHODS
PubMed, EMBASE, the Cochrane Library, and Web of Science databases were searched to retrieve studies that compared PBR with SBR after mastectomies. The outcomes were complications, oncological safety, patient-reported outcomes and postoperative pain. Revman software version 5.30 and stata vesion 12 was used to conduct meta-analysis where possible.
RESULTS
16 comparative studies (12 articles and four abstracts) were included. The meta analysis showed no statistical differences in overall complications, implant loss, seroma, nipple or skin flap necrosis, hematoma, reoperation, wound dehiscence, and wound-skin infection, rippling between PBR and SBR. PBR might be associated with fewer nipple or skin flap necrosis for those who received tissue expander placement, and fewer capsular contracture rates for those who received implant. PBR might be associated with better Breast Q scores and less postoperative pain without increasing the risk of local recurrence and metastatic disease.
CONCLUSION
Although available evidence is limited, PBR might be as safe as subpectoral approach. Future well designed multicenter randomized controlled trial that compare postmastectomy PBR with SBR is needed.
Topics: Female; Humans; Mammaplasty; Mastectomy; Pain, Postoperative; Patient Reported Outcome Measures; Pectoralis Muscles
PubMed: 31256950
DOI: 10.1016/j.ejso.2019.05.015 -
Annals of Plastic Surgery Dec 2022Reconstruction of the thumb is among the most complex challenges faced by hand surgeons. Meaningful functional recovery of the thumb is dependent mainly on thumb...
Reconstruction of the thumb is among the most complex challenges faced by hand surgeons. Meaningful functional recovery of the thumb is dependent mainly on thumb opposition and palmar abduction. Free functional muscle transfer provides neurotized, robust soft tissue coverage that can achieve dynamic reconstruction of thenar musculature in a single stage.We present a case of a free neurotized segmental gracilis muscle transfer for thenar reconstruction and a systematic review of thenar reconstruction with free functional muscle transfer in the literature. A teenage male patient with a gunshot-induced thenar defect was reconstructed using a free neurotized gracilis muscle measuring 5 × 11 cm. The obturator nerve was coapted to the recurrent motor branch of the median nerve. The patient reached M4 strength at 10 months with functional use of his thumb. A systematic review of options for functional thenar reconstruction revealed 14 studies describing functional thenar reconstruction in 44 patients. Successful functional flaps described included gracilis muscle, pronator quadratus muscle, pectoralis minor muscle, abductor hallucis muscle, extensor digitorum brevis muscle, and serratus anterior muscle. Microsurgical transfer of a functional muscle is an excellent option for single-stage thenar reconstruction of both form and function. There are a number of available donor sites with equivalent size and bulk to that of native thenar musculature.
Topics: Adolescent; Humans; Male; Hand; Thumb; Surgical Flaps; Muscle, Skeletal; Pectoralis Muscles
PubMed: 36416708
DOI: 10.1097/SAP.0000000000003309 -
Clinical Anatomy (New York, N.Y.) Oct 2019The presence of structural in-series continuity between skeletal muscles has been confirmed in the trunk and lower extremity. However, it is not yet clear whether the...
The presence of structural in-series continuity between skeletal muscles has been confirmed in the trunk and lower extremity. However, it is not yet clear whether the same architecture can be found in the upper limb. Therefore, the aim of the present study was to review the available literature considering the existence of myofascial chains in the shoulder-arm region. Two independent investigators performed a systematic literature search using MEDLINE (PubMed) and Google Scholar (each 1900-2019). Peer-reviewed anatomical dissection studies reporting myofascial in-series continuity in the upper extremity were included. The methodological quality of the included studies was assessed by the QUACS scale. Thirteen studies were included in the review. Analysis of these papers led to the identification of three myofascial chains: the ventral arm chain (pectoralis major, brachial fascia/biceps brachii, flexor carpi ulnaris/brachioradialis/supinator, based on five studies); the lateral arm chain (trapezius, deltoideus, lateral intermuscular septum/brachialis, brachioradialis, four studies); and the dorsal arm chain (latissiumus dorsi/teres minor/infraspinatus, triceps brachii, anconeus, extensor carpi ulnaris, six studies). There is good evidence for direct serial tissue continuity extending from the neck and shoulder region to the forearm. Despite this intriguing finding, which could have implications for health professionals and the treatment of musculoskeletal disorders, further research is needed to establish the mechanical relevance of the identified myofascial chains. Clin. Anat. 32:934-940, 2019. © 2019 Wiley Periodicals, Inc.
Topics: Connective Tissue; Fascia; Humans; Muscle, Skeletal; Upper Extremity
PubMed: 31226229
DOI: 10.1002/ca.23424 -
International Journal of Sports... 2024Swimming is enjoyed by athletes of all ages, and shoulder pain is a common problem. Clinicians identify impairments which impact shoulder pain and these impairments may...
BACKGROUND
Swimming is enjoyed by athletes of all ages, and shoulder pain is a common problem. Clinicians identify impairments which impact shoulder pain and these impairments may differ depending on the swimmer's age competition level.
PURPOSE
The purpose of this study was to investigate objective measures utilized to assess swimmers and assess the relationship of test values to shoulder pain in distinct age groups/competition levels. A secondary aim was to report normative/expected values for these tests.
DESIGN
Systematic review.
METHODS
PRISMA methodology was employed to assess studies evaluating clinical tests and measures associated with shoulder pain for swimmers in varied age competition levels. The Methodological Index for Non-Randomized Studies instrument was used to evaluate the quality of the included studies, and a qualitative synthesis of findings was conducted to determine the strength of the evidence in four age competition levels for nine objective measures. Distinct cut points for proposed measures were identified.
RESULTS
Twenty-seven studies were included in the analysis and the majority were of moderate quality in adolescent/adult swimmers. Youth swimmers had limited evidence for the development of shoulder pain associated with scapular position/dyskinesia, weakness of periscapular muscles, low endurance of core muscles, and moderate evidence for shoulder pain associated with laxity and altered range of motion (ROM). Adolescent/adult swimmers demonstrated limited evidence for a positive association between developing shoulder pain if there is a low eccentric ER:concentric IR ratio, and moderate evidence for pectoralis minor tightness and glenohumeral laxity. There were limited studies regarding masters swimmers to derive conclusive evidence. Cut points were identified from the included studies but these have not been validated in other studies.
CONCLUSION
Swimmers of various ages may have different objective clinical tests and measures associated with the risk for developing shoulder pain. More studies are needed to fully understand risk factors for shoulder pain in the masters swim competition level, and to validate recommended cut points for various tests and measures.
KEY LEVEL OF EVIDENCE
3, Systematic review of mostly Level 3 studies.
PubMed: 38179580
DOI: 10.26603/001c.90282 -
Seminars in Thrombosis and Hemostasis Feb 2022Coagulation abnormalities, thrombosis, and endothelial dysfunction have been described in COVID-19 patients. Spontaneous muscle hematoma (SMH) is a rare complication in...
Coagulation abnormalities, thrombosis, and endothelial dysfunction have been described in COVID-19 patients. Spontaneous muscle hematoma (SMH) is a rare complication in COVID-19. The aims of this study are to: (1) perform a systematic review of the literature to better define the clinical SMH characteristics, (2) describe the prevalence and the clinical characteristics of SMH in COVID-19 patients referring to a Department of Internal Medicine (IM) (Federico II University of Naples), a Department of Sub-Intensive Care Medicine (SIM) (Ospedale Del Mare), and a Department of Intensive Care Unit (ICU) (Federico II University). The systematic review was performed according to PRISMA criteria. The local prevalence of SMH in COVID-19 was evaluated retrospectively. The medical records of all COVID-19 patients referring to IM and ICU from March 11th, 2020, to February 28th, 2021 were examined for SMH occurrence. In our retrospective analysis, we describe 10 cases of COVID-19 patients with SMH not previously reported in literature, with a prevalence of 2.1%. The literature review, inclusive of our case series, describes a total of 50 SMHs in COVID-19 patients (57.4% males; mean age 68.8 ± 10.0 years). The SMH sites were ileo-psoas, vastus intermedius, gluteus, sternocleidomastoid, and pectoralis major muscles. Males developed SMH earlier than females (9.5 ± 7.8 vs. 17.1 ± 9.7 days). Ileo-psoas hematoma was more frequent in males (69.2 vs. 30.8%), while pectoralis major hematoma occurred only in females. The in-hospital mortality rate of SMH in COVID-19 patients was 32.4%. SMH is a rare but severe complication in COVID-19 hospitalized patients, associated with high mortality. A gender difference seems to be present in the clinical presentation of the disorder.
Topics: Aged; Animals; COVID-19; Female; Hematoma; Horses; Humans; Male; Middle Aged; Muscles; Retrospective Studies; SARS-CoV-2
PubMed: 34388842
DOI: 10.1055/s-0041-1732370 -
Plastic and Reconstructive Surgery Feb 2021In the past decade, surgeons have increasingly advocated for a return to prepectoral breast reconstruction with claims that surgical mesh (including acellular dermal... (Comparative Study)
Comparative Study
BACKGROUND
In the past decade, surgeons have increasingly advocated for a return to prepectoral breast reconstruction with claims that surgical mesh (including acellular dermal matrix) can reduce complication rates. However, numerous surgical and implant advancements have occurred in the decades since the initial prepectoral studies, and it is unclear whether mesh is solely responsible for the touted benefits.
METHODS
The authors conducted a systematic review of all English language articles reporting original data for prepectoral implant-based breast reconstruction. Articles presenting duplicate data were excluded. Complications were recorded and calculated on a per-breast basis and separated as mesh-assisted, no-mesh prior to 2006, and no-mesh after 2006 (date of first silicone gel-filled breast implant approval). Capsular contracture comparisons were adjusted for duration of follow-up.
RESULTS
A total of 58 articles were included encompassing 3120 patients from 1966 to 2019. The majority of the included studies were retrospective case series. Reported complication outcomes were variable, with no significant difference between groups in hematoma, infection, or explantation rates. Capsular contracture rates were higher in historical no-mesh cohorts, whereas seroma rates were higher in contemporary no-mesh cohorts.
CONCLUSIONS
Limited data exist to understand the benefits of surgical mesh devices in prepectoral breast reconstruction. Level I studies with an appropriate control group are needed to better understand the specific role of mesh for these procedures. Existing data are inconclusive but suggest that prepectoral breast reconstruction can be safely performed without surgical mesh.
Topics: Breast Implantation; Breast Implants; Breast Neoplasms; Device Removal; Esthetics; Female; Humans; Implant Capsular Contracture; Mastectomy; Pectoralis Muscles; Surgical Mesh; Surgical Wound Infection; Treatment Outcome
PubMed: 33177453
DOI: 10.1097/PRS.0000000000007586