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Musculoskeletal Science & Practice Aug 2023Shoulder symptoms are common in patients with hypermobility spectrum disorders (HSD), but few studies focus on identifying factors associated with treatment effects. (Randomized Controlled Trial)
Randomized Controlled Trial
Psychological factors and symptom duration are associated with exercise-based treatment effect in people with hypermobile shoulders: A secondary analysis of a randomised controlled trial.
BACKGROUND
Shoulder symptoms are common in patients with hypermobility spectrum disorders (HSD), but few studies focus on identifying factors associated with treatment effects.
AIM
To identify baseline and clinical characteristics associated with a better outcome 16 weeks after starting an exercise-based treatment in patients with HSD and shoulder symptoms.
DESIGN
Exploratory secondary analysis of data from a randomised controlled trial.
METHOD
Self-reported treatment outcome was reported as change between baseline and follow-up after 16 weeks of high-load or low-load shoulder strengthening. Multiple linear and logistic regressions were used to investigate associations of patient expectations of treatment effect, self-efficacy, fear of movement, and symptom duration with change in shoulder function, shoulder pain, quality of life, and patient reported health change. All regression models were performed firstly with adjustments for covariates (age, sex, body mass index, hand dominance, treatment group, and baseline score of the outcome variable) and secondly with additional adjustments for exposure variables.
RESULTS
Expectations of complete recovery were associated with an increased odds of perceiving an important improvement in physical symptoms after a 16-week exercise-based treatment program. Higher self-efficacy at baseline seemed to be associated with improved shoulder function, shoulder pain and quality of life. A higher fear of movement seemed to be associated with increased shoulder pain and decreased quality of life. A longer symptom duration was associated with decreased quality of life.
CONCLUSION
Expectations of complete recovery, higher self-efficacy, lower fear of movement and shorter symptom duration seem to be important for better treatment outcomes.
Topics: Humans; Shoulder; Exercise Therapy; Shoulder Pain; Quality of Life; Exercise
PubMed: 37331257
DOI: 10.1016/j.msksp.2023.102798 -
The American Journal of Sports Medicine Jul 2020Pathological muscle activation patterns of the external rotators and periscapular muscles can result in posterior positional functional shoulder instability (PP-FSI). In... (Clinical Trial)
Clinical Trial
BACKGROUND
Pathological muscle activation patterns of the external rotators and periscapular muscles can result in posterior positional functional shoulder instability (PP-FSI). In several patients, physical therapy and surgical treatment are not successful.
PURPOSE
The shoulder-pacemaker treatment concept was evaluated prospectively in patients with PP-FSI and previously failed conventional therapy attempt.
STUDY DESIGN
Case series; Level of evidence, 4.
METHODS
A negative selection of 24 consecutive cases of noncontrollable PP-FSI in 16 patients with previously failed conventional therapy were included in this prospective study. The shoulder-pacemaker treatment consisted of an electrical muscle stimulation-based therapy protocol with 9 to 18 one-hour treatment sessions. Two patients were excluded because of nonadherence to the training schedule, leaving a final study cohort of 21 cases in 14 patients. Follow-up included assessment of clinical function, impairment during daily activities and sports, satisfaction, Western Ontario Shoulder Instability Index (WOSI), Rowe score, and Subjective Shoulder Value at 0 weeks, 2 weeks, 4 weeks, 3 months, 6 months, 12 months, and 24 months after intervention.
RESULTS
WOSI, Subjective Shoulder Value, and Rowe score showed a highly significant improvement at all time points of follow-up ( < .001). Young age ( = .005), low weight ( = .019), shoulder activity level ( = .003), unilateral affliction ( = .046), and higher baseline WOSI score ( = .04) were associated with a better treatment effect. Cases with increased glenoid retroversion, posterior scapulohumeral decentering, and dysplastic bony glenoid shape showed a trend toward shorter treatment effect duration. No complications during the intervention or follow-up period were observed.
CONCLUSION
The shoulder-pacemaker therapy concept is an effective treatment with rapid improvement and sustained outcome over the course of 2 years in patients with noncontrollable PP-FSI with previously failed conventional treatment. Young and more athletic patients with lower weight and unilateral pathology respond best to the treatment.
Topics: Electric Stimulation Therapy; Humans; Joint Instability; Prospective Studies; Shoulder; Shoulder Dislocation; Shoulder Joint
PubMed: 32667266
DOI: 10.1177/0363546520933841 -
F1000Research 2022Shoulder biomechanics cannot be measured directly in living persons. While different glenohumeral joint simulators have been developed to investigate the role of the...
Shoulder biomechanics cannot be measured directly in living persons. While different glenohumeral joint simulators have been developed to investigate the role of the glenohumeral muscles in shoulder biomechanics, a standard for these simulators has not been defined. With this scoping review we want to describe available ex-vivo experimental strategies for assessing unconstrained shoulder biomechanics. The scoping review aims at identifying methodological and/or experimental studies describing or involving ex-vivo simulators that assess unconstrained shoulder biomechanics and synthesizing their strengths and limitations. All unconstrained glenohumeral joint simulators published in connection with ex-vivo or mechanical simulation experiments will be included. Studies on glenohumeral simulators with active components to mimic the muscles will be included. We will exclude studies where the experiment is static or the motion is induced through an external guide, e.g., a robotic device. We will perform database searching in PubMed, Embase via Elsevier and Web of Science. Two reviewers will independently assess full texts of selected abstracts. Direct backward and forward citation tracking on included articles will be conducted. We will narratively synthesize the results and derive recommendations for designing ex-vivo simulators for assessing unconstrained shoulder biomechanics.
Topics: Shoulder; Biomechanical Phenomena; Shoulder Joint; Muscles; Movement; Review Literature as Topic
PubMed: 36704048
DOI: 10.12688/f1000research.72856.3 -
BMC Musculoskeletal Disorders Jan 2023Posterior shoulder dislocations are rare injuries that are often missed on initial presentation. Cases left untreated for more than three weeks are considered chronic,...
BACKGROUND
Posterior shoulder dislocations are rare injuries that are often missed on initial presentation. Cases left untreated for more than three weeks are considered chronic, cannot be reduced closely (they become locked) and are usually associated with a significant reverse Hill-Sachs defect. The aim of this study was to evaluate the outcomes of chronic locked posterior shoulder dislocations treated with the McLaughlin procedure (classic or modified).
METHODS
This retrospective study included 12 patients with chronic locked posterior shoulder dislocation operated on between 2000 and 2021 by two surgeons in two institutions. Patients received a thorough clinical examination and radiological assessment before and after surgery. Shoulders were repaired with the McLaughlin or modified McLaughlin procedure. Outcomes were assessed by comparing pre- and postoperative values of clinical variables.
RESULTS
Most of the dislocations were of traumatic origin. The average delay between dislocation and surgical reduction was 13.5 ± 9.7 weeks. Postoperative clinical outcomes were favourable, with an average subjective shoulder value of 86.4 ± 11.1 and a normalized Constant -Murley score of 90 ± 8.3. None of the patients had a recurrence of shoulder dislocation, but one patient developed avascular necrosis of the humeral head and two patients developed glenohumeral osteoarthritis.
CONCLUSIONS
In this group of patients with chronic locked posterior shoulder dislocation, the clinical outcomes of McLaughlin and modified McLaughlin procedures were satisfactory, even when surgery was significantly delayed.
Topics: Humans; Shoulder; Retrospective Studies; Shoulder Dislocation; Joint Dislocations; Treatment Outcome
PubMed: 36721138
DOI: 10.1186/s12891-023-06200-8 -
PloS One 2019The aims of this study were to analyze the shoulder functional profile of young male and female tennis players and to establish the relationship among physical variables...
OBJECTIVE
The aims of this study were to analyze the shoulder functional profile of young male and female tennis players and to establish the relationship among physical variables and serve speed.
METHODS
A total of 128 Spanish tennis players (Under-13 (n = 32/32 males/females) and Under-15 (n = 36/28 males/females), were tested during National training camps. Tests included passive shoulder range of motion (ROM) for both internal (IR) and external rotation (ER) and isometric strength (i.e., IR and ER) of the dominant/non-dominant shoulders, medicine ball throws (MBT), and serve speed. Age and sex pairwise comparisons were carried using the Hedges' g index (dg).
RESULTS
Results showed age and sex effects on serve speed and all MBT, with males showing greater changes (1.51≤dg≤1.98) with age than females (0.92≤dg≤1.35; p<0.05). U15 males showed higher (p<0.05) absolute shoulder IR and ER strength than U13, with only significant differences between males and females in the U15. Regarding ROM, U15 males showed a decreased IR ROM compared to U13 (dg = -0.84; p<0.05) and higher significant IR bilateral deficit (dg = 0.51; p<0.05). The distances obtained in the different MBT were the variables more correlated to serve speed.
CONCLUSION
The present results suggest that shoulder strength, medicine ball throws and serve speed increased along with age in young elite tennis players of both sexes. However, a decreased range of motion and bilateral deficit for glenohumeral internal rotation is evident in male under-15 tennis players. Muscle strength, power and shoulder range of motion are key factors for serve speed in young tennis players.
Topics: Adolescent; Age Factors; Athletic Performance; Child; Female; Humans; Isometric Contraction; Male; Muscle Strength; Range of Motion, Articular; Rotation; Sex Factors; Shoulder; Shoulder Joint; Spain; Tennis
PubMed: 31479492
DOI: 10.1371/journal.pone.0221761 -
Medicina (Kaunas, Lithuania) Jan 2021Sleeper stretching (SS) can improve the shoulder's range of motion (ROM) for pitchers with glenohumeral internal rotation deficit (GIRD). However, no evidence has proven...
Comparison of the Acute Effects of Kinesio Taping and Sleeper Stretching on the Shoulder Rotation Range of Motion, Manual Muscle Strength, and Sub-Acromial Space in Pitchers with Glenohumeral Internal Rotation Deficit.
BACKGROUND AND OBJECTIVES
Sleeper stretching (SS) can improve the shoulder's range of motion (ROM) for pitchers with glenohumeral internal rotation deficit (GIRD). However, no evidence has proven the effect of Kinesio taping (KT) on shoulder strength and ROM. Therefore, this study compared the effects of SS and KT on shoulder rotation ROM, muscle strength, and sub-acromial distance in pitchers with GIRD.
MATERIALS AND METHODS
Thirty-one pitchers with GIRD were allocated into control, KT, and SS groups. Shoulder rotation ROM, muscle strength, and sub-acromial space were measured before and after treatment with SS or KT.
RESULTS
The results revealed that KT and SS significantly enhanced shoulder rotation ROM in pitchers with GIRD. External rotator strength significantly increased following KT but significantly decreased after SS. KT and SS exerted no effects on the sub-acromial space.
CONCLUSIONS
KT and SS improve shoulder rotation ROM in pitchers with GIRD. In addition, KT improves shoulder external rotator strength, and SS reduces it.
Topics: Baseball; Humans; Muscle Strength; Range of Motion, Articular; Rotation; Shoulder; Shoulder Joint
PubMed: 33498704
DOI: 10.3390/medicina57020102 -
Journal of Shoulder and Elbow Surgery Feb 2023Scapular winging is a rare condition of the shoulder girdle that presents challenging treatment decisions for clinicians. To inform clinical practice, clinicians need... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Scapular winging is a rare condition of the shoulder girdle that presents challenging treatment decisions for clinicians. To inform clinical practice, clinicians need guidance on what the best treatment decision is for their patients, and such recommendations should be based on the total evidence available. Therefore, the purpose of this review was to systematically review the evidence regarding nonsurgical management and tendon transfer surgery of patients with neurologic scapular winging due to serratus anterior (SA) or trapezius (TP) palsy.
METHODS
PubMed, Embase, Web of Science, Cochrane Library, Emcare, and Academic Search Premier were searched up to April 5, 2022, for studies reporting on clinical outcomes after nonsurgical management and tendon transfer surgery of scapular winging due to weakness of the SA or TP muscle. The Integrated quality Criteria for Review Of Multiple Study (ICROMS) tool was used to classify the quality of the studies. Primary outcomes were the fraction of patients with spontaneous recovery after nonsurgical management and improvement in shoulder function, pain scores, and shoulder scores after tendon transfer surgery. Data were pooled if data on the same outcome were available for at least 3 studies, using random-effects meta-analysis.
RESULTS
Twenty-three (10 moderate-quality [MQ] and 13 low-quality) studies were included. Six studies (3 MQ; 234 shoulders) reported on outcomes after nonsurgical management of SA palsy, whereas 12 (6 MQ; 221 shoulders) and 6 studies (1 MQ; 80 shoulders) evaluated the outcomes of tendon transfer for SA or TP palsy (1 study addressed both). Spontaneous recovery of scapular winging with nonsurgical management varied between 21% and 78% across studies after a median follow-up of 72 months. For surgical management of SA palsy, pooling data in a meta-analysis showed that patients on average improved by 47° (95% confidence interval [CI]: 34-61, P ≤ .001) in active forward flexion, had lower visual analog scale scores for pain (mean difference [MD]: -3.0, 95% CI: -4.9 to -1.0, P = .003), and had substantial improvements in American Shoulder and Elbow Surgeons (MD: 24, 95% CI: 9-39, P = .002) and Constant scores (MD: 45, 95% CI: 39-51, P ≤ .001). Patients with TP palsy on average improved by 36° (95% CI: 21-51, P ≤ .001) in active forward flexion after tendon transfer. Statistical pooling was not possible for other outcome measures as insufficient data were available.
CONCLUSION
A substantial part of nonsurgically managed patients with scapular winging seem to have persistent complaints, which should be part of the information provided to patients. Data pooling demonstrated significant improvements in shoulder function, pain scores, and shoulder scores after tendon transfer surgery, but higher quality evidence is needed to allow for more robust recommendations and guide clinical decision-making on when to perform such functional surgery.
Topics: Humans; Tendon Transfer; Scapula; Shoulder; Paralysis; Pain
PubMed: 36252782
DOI: 10.1016/j.jse.2022.09.009 -
Hand (New York, N.Y.) Jan 2022The objective of this work was to perform a critical review of the 2-dimensional and 3-dimensional anatomy of the adult brachial plexus divisions and cords. Twelve... (Review)
Review
The objective of this work was to perform a critical review of the 2-dimensional and 3-dimensional anatomy of the adult brachial plexus divisions and cords. Twelve adult brachial plexuses from fresh cadavers were dissected. All were male and aged between 30 and 50 years. Only corpses without brachial plexus injuries were selected. The purpose of the dissections was to identify the origin of the anterior and posterior divisions of the adult brachial plexus in their respective trunks, as well as the positioning of the posterior, lateral, and medial cords. The posterior division of all trunks had a cranial and dorsal origin, while the anterior division of all trunks had a caudal and ventral origin. The posterior cord was the most cranial of all, the lateral cord was central, and the medial cord was the most caudal of all cords. The posterior division of the superior trunk was always between the suprascapular nerve and the anterior division. Brachial plexus diagrams in most textbooks and papers are different from what was found in our dissections. Contrary to the known diagram, the posterior divisions always had a cranial origin in the superior, middle, and inferior trunks.
Topics: Adult; Brachial Plexus; Cadaver; Dissection; Humans; Male; Middle Aged; Shoulder
PubMed: 32100569
DOI: 10.1177/1558944720906510 -
Contrast Media & Molecular Imaging 2022This study aims to ensure the wide application of ultrasound-guided superior brachial plexus block in shoulder surgery, solve the application problem of...
This study aims to ensure the wide application of ultrasound-guided superior brachial plexus block in shoulder surgery, solve the application problem of ultrasound-guided superior brachial plexus block in shoulder surgery, make up for severe postoperative pain after shoulder arthroscopy, and improve the patient's recovery ability. In this paper, 90 patients with shoulder arthroscopy were divided into 3 groups: A, B, and C. In recent years, with the rapid development of medicine, ultrasound-guided brachial plexus upper trunk block has been widely used in shoulder surgery. Shoulder arthroscopy is more and more used in the diagnosis and treatment of shoulder diseases because of its advantages of minimally invasive, safe, and rapid recovery. Compared with the traditional operation, it is found that the shoulder arthroscopic operation reduces the incision trauma through the microscope, but the shoulder operation involves more muscles and ligaments, so the perioperative pain of shoulder arthroscopic operation is still serious.
Topics: Arthroscopy; Brachial Plexus Block; Humans; Pain, Postoperative; Shoulder; Ultrasonography, Interventional
PubMed: 35833076
DOI: 10.1155/2022/9168566 -
Journal of Orthopaedic Surgery and... Apr 2020To discuss the clinical efficacy and safety of scapuloplasty treating the shoulder imbalance in scoliosis patients.
BACKGROUND
To discuss the clinical efficacy and safety of scapuloplasty treating the shoulder imbalance in scoliosis patients.
METHODS
A retrospective analysis was made on 21 patients who underwent scoliosis corrective surgery combined with scapuloplasty from September 2013 to March 2015. The average follow-up was 31.4 ± 5.3 months (24-42 months). The shoulder vertical difference (SVD), adjusted Constant-Murley score, range of shoulder motion function, Cavendish grade, and the overall satisfaction were compared among the pre-surgery, post-surgery, and the final follow-up periods.
RESULTS
The shoulder vertical difference (SVD) significantly decreased at the time of post-surgery and the final follow-up, comparing the score of the pre-surgery. The SVD of all patients were decreased from preoperatively 3.2 ± 1.1 cm to 0.4 ± 0.3 cm, with the Cavendish grade improved to grade 1 at the final follow-up. The adjusted Constant-Murley score and range of shoulder motion function showed no significant difference during the three time periods (p > 0.05). And no severe complications had occurred over 2 years follow-up.
CONCLUSION
The scapuloplasty surgery shows to be an effective and safety procedure to improve the shoulder imbalance, cosmetic appearance, and the overall satisfaction in scoliosis patients without impairing the shoulder function, which can be widely applied in clinic.
Topics: Adolescent; Adult; Female; Follow-Up Studies; Humans; Male; Postural Balance; Plastic Surgery Procedures; Retrospective Studies; Scapula; Scoliosis; Shoulder; Treatment Outcome; Young Adult
PubMed: 32299457
DOI: 10.1186/s13018-020-01676-9