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Clinics in Shoulder and Elbow Jun 2024
PubMed: 38738321
DOI: 10.5397/cise.2021.00563.e1 -
Clinics in Shoulder and Elbow Jun 2024Standard open acromioclavicular (AC) stabilization is associated with increased postoperative complications including deltoid injury, infection, tunnel complications,...
BACKGROUND
Standard open acromioclavicular (AC) stabilization is associated with increased postoperative complications including deltoid injury, infection, tunnel complications, loss of reduction, and wound/cosmetic concerns. Arthroscopy may offer superior visualization and advantages that limit these risks. The aim of this prospective non-randomized study is to evaluate advantages and long-term reliability of arthroscopic AC stabilization.
METHODS
Thirty-two patients with acute grade III, IV and V AC dislocations underwent arthroscopic AC reconstruction with long-term assessment by clinical AC examination, Simple Shoulder Test, American Shoulder and Elbow Surgeons scores, visual analog scale, Specific AC Score and Quick Disabilities of the Arm, Shoulder and Hand scores. Radiographs verified conservation of initial reduction and presence of coracoclavicular (CC) ossifications. Complications, revision rate, and satisfaction were assessed and compared to the literature.
RESULTS
Mean follow-up time was 67.6 months. All clinical outcome scores improved and differences were statistically significant (P<0.001). Initial postoperative radiographs consistently showed complete reduction. Two patients experienced relapse to grade II AC dislocation without clinical implications. In total, 71.8% showed CC ossifications without functional impairment, and in 31.3% concomitant injuries were observed. Reintervention rate was 9.4%, and 96.9% of patients were satisfied with procedure outcomes.
CONCLUSIONS
Arthroscopic stabilization for acute AC joint dislocations offers satisfactory clinical and radiographic outcomes, and our results show that the arthroscopic technique is reliable in the long run. We report better reduction in maintenance, fewer complications, and similar reoperation rates compared to other techniques. Level of evidence: III.
PubMed: 38738320
DOI: 10.5397/cise.2023.01060 -
BMC Neurology May 2024Restoring shoulder function is critical for upper-extremity rehabilitation following a stroke. The complex musculoskeletal anatomy of the shoulder presents a challenge...
BACKGROUND
Restoring shoulder function is critical for upper-extremity rehabilitation following a stroke. The complex musculoskeletal anatomy of the shoulder presents a challenge for safely assisting elevation movements through robotic interventions. The level of shoulder elevation assistance in rehabilitation is often based on clinical judgment. There is no standardized method for deriving an optimal level of assistance, underscoring the importance of addressing abnormal movements during shoulder elevation, such as abnormal synergies and compensatory actions. This study aimed to investigate the effectiveness and safety of a newly developed shoulder elevation exoskeleton robot by applying a novel optimization technique derived from the muscle synergy index.
METHODS
Twelve chronic stroke participants underwent an intervention consisting of 100 robot-assisted shoulder elevation exercises (10 × 10 times, approximately 40 min) for 10 days (4-5 times/week). The optimal robot assist rate was derived by detecting the change points using the co-contraction index, calculated from electromyogram (EMG) data obtained from the anterior deltoid and biceps brachii muscles during shoulder elevation at the initial evaluation. The primary outcomes were the Fugl-Meyer assessment-upper extremity (FMA-UE) shoulder/elbow/forearm score, kinematic outcomes (maximum angle of voluntary shoulder flexion and elbow flexion ratio during shoulder elevation), and shoulder pain outcomes (pain-free passive shoulder flexion range of motion [ROM] and visual analogue scale for pain severity during shoulder flexion). The effectiveness and safety of robotic therapy were examined using the Wilcoxon signed-rank sum test.
RESULTS
All 12 patients completed the procedure without any adverse events. Two participants were excluded from the analysis because the EMG of the biceps brachii was not obtained. Ten participants (five men and five women; mean age: 57.0 [5.5] years; mean FMA-UE total score: 18.7 [10.5] points) showed significant improvement in the FMA-UE shoulder/elbow/forearm score, kinematic outcomes, and pain-free passive shoulder flexion ROM (P < 0.05). The shoulder pain outcomes remained unchanged or improved in all patients.
CONCLUSIONS
The study presents a method for deriving the optimal robotic assist rate. Rehabilitation using a shoulder robot based on this derived optimal assist rate showed the possibility of safely improving the upper-extremity function in patients with severe stroke in the chronic phase.
Topics: Humans; Male; Female; Stroke Rehabilitation; Middle Aged; Feasibility Studies; Exoskeleton Device; Aged; Shoulder; Electromyography; Muscle, Skeletal; Range of Motion, Articular; Exercise Therapy; Stroke; Robotics; Biomechanical Phenomena; Adult
PubMed: 38724916
DOI: 10.1186/s12883-024-03651-x -
Frontiers in Physiology 2024The use of elastomeric technology in sports garments is increasing in popularity; however, its specific impact on physiological and psychological variables is not fully...
The use of elastomeric technology in sports garments is increasing in popularity; however, its specific impact on physiological and psychological variables is not fully understood. Thus, we aimed to analyze the physiological (muscle activation of the pectoralis major, triceps brachii, anterior deltoid, and rectus abdominis, capillary blood lactate, systolic and diastolic blood pressure, and heart rate) and psychological (global and respiratory rating of perceived exertion [RPE]) responses during an incremental treadmill test wearing a new sports garment for the upper body that incorporates elastomeric technology or a placebo garment. Eighteen physically active young adults participated in two randomized sessions, one wearing the elastomeric garment and the other wearing a placebo. Participants performed in both sessions the same treadmill incremental test (i.e., starting at 8 km/h, an increase of 2 km/h each stage, stage duration of 3 min, and inclination of 1%; the test ended after completing the 18 km/h Stage or participant volitional exhaustion). The dependent variables were assessed before, during, and/or after the test. Nonparametric tests evaluated differences. The elastomeric garment led to a greater muscle activation ( < 0.05) in the pectoralis major at 16 km/h (+33.35%, = 0.01, = 0.47) and 18 km/h (+32.09%, = 0.02, = 0.55) and in the triceps brachii at 10 km/h (+20.28%, = 0.01, = 0.41) and 12 km/h (+34.95%, = 0.04, = 0.28). Additionally, lower lactate was observed at the end of the test (-7.81%, = 0.01, = 0.68) and after 5 min of recovery (-13.71%, < 0.001, = 1.00) with the elastomeric garment. Nonsignificant differences between the garments were encountered in the time to exhaustion, cardiovascular responses, or ratings of perceived exertion. These findings suggest that elastomeric garments enhance physiological responses (muscle activation and blood lactate) during an incremental treadmill test without impairing physical performance or effort perception.
PubMed: 38711952
DOI: 10.3389/fphys.2024.1372020 -
JSES International May 2024The deltoid is a trisegmented muscle with anterior, middle, and posterior components. While the clinical relevance of the presence of anatomic variations of the deltoid...
BACKGROUND
The deltoid is a trisegmented muscle with anterior, middle, and posterior components. While the clinical relevance of the presence of anatomic variations of the deltoid origin and insertion continues to be debated, the architecture of the deltoid muscle is more complex than initially believed. This study aimed to evaluate the gross anatomy of the deltoid muscle insertion by qualitatively and quantitatively characterizing the insertion and location of the deltoid muscle's anterior, middle, and posterior components. This information is valuable to surgeons as it raises awareness of potential variants that could be encountered during surgery, promotes mindfulness of neurovascular proximities, and reduces the likelihood of confusion between adjacent muscle fibers.
METHODS
Eight nonpaired, fresh-frozen clavicle-to-fingertip cadaveric shoulders were acquired for the study (6 left, 2 right). The average age of the cadavers was 79.5 years (range: 64-92). The standard deltopectoral approach was carried out on all specimens. The planes dividing the anterior, middle, and posterior deltoid were identified and marked. Once complete exposure had been achieved, digital calipers were used to record the size of the deltoid insertion. The specimens were qualitatively assessed to characterize the style of insertion they demonstrated.
RESULTS
The average length of the deltoid insertion was 39.45 ± 9.33 mm (n = 8). Six of the eight shoulders demonstrated an insertion style previously characterized in the literature. The remaining two shoulders highlighted an insertion pattern not previously described.
CONCLUSION
The current study demonstrates a novel insertion pattern for the deltoid muscle that has not been previously characterized. This "step-off" insertion pattern shows that the anterior, middle, and posterior tendons are inserted superior-medial, directly on, and inferior-lateral to the deltoid tuberosity and was found in 2/8 of our cadaveric specimens.
PubMed: 38707574
DOI: 10.1016/j.jseint.2024.01.013 -
JSES International May 2024Hemiarthroplasty (HHR) using a smaller head with rotator cuff reconstruction is a treatment option for cuff-tear arthropathy, offering advantages like facilitating...
BACKGROUND
Hemiarthroplasty (HHR) using a smaller head with rotator cuff reconstruction is a treatment option for cuff-tear arthropathy, offering advantages like facilitating rotator cuff-tear closure, increasing the lever arm of deltoid, and restoring function in irreparable cuff tears. This study aimed to evaluate the long-term outcomes of this procedure.
METHODS
A retrospective analysis was conducted for 91 shoulders undergoing HHR using a smaller head with rotator cuff reconstruction between May 2005 and September 2012. Surgery involved reducing the size of humeral head and performing rotator cuff reconstruction based on the site of the deficient rotator cuff. The study analyzed University of California, Los Angeles shoulder scores, Japanese Orthopaedics Association shoulder scores, range of motion, and postoperative radiographs.
RESULTS
Twenty-eight patients, divided into an elderly group (14 women, 2 men, mean age 74.5 ± 3.8 years) and a younger group (6 women, 6 men, mean age 63.5 ± 3.1 years) were followed up for a mean of 133.2 ± 14.1 months. No complications were reported. The clinical scores and range of motion significantly improved postoperatively and remained over 10 years. Radiographs revealed high incidence of glenoid wear (82.1%), bone resorption (43%) and cranial humeral head migration (54%), with no prosthesis loosening.
CONCLUSION
We believe that HHR using a smaller head with rotator cuff reconstruction is a surgical technique that can maintain stable long-term outcomes in both elderly and younger individuals with cuff-tear arthropathy.
PubMed: 38707560
DOI: 10.1016/j.jseint.2023.12.006 -
Journal of Human Kinetics Mar 2024The current study compared the spatial excitation of the primary muscles during the lat pull-down exercise with the bar passing in front (front-LPD) or behind the neck...
The current study compared the spatial excitation of the primary muscles during the lat pull-down exercise with the bar passing in front (front-LPD) or behind the neck (back-LPD) using high-density electromyography. Fourteen resistance trained men performed a front-LPD or a back-LPD within a non-fatiguing set with 8-RM as the external load. The muscle excitation centroid of latissimus dorsi, middle trapezius, pectoralis major, biceps brachii, triceps brachii and posterior deltoid muscles were recorded during the ascending and the descending phase. During the descending phase, the front-LPD showed superior excitation of the latissimus dorsi (ES = 0.97) and the pectoralis major (ES = 1.17), while in the ascending phase, the back-LPD exhibited superior excitation of the latissimus dorsi (ES = 0.63), and the front-LPD showed superior excitation of the biceps brachii (ES = 0.41) and the posterior deltoid (ES = 1.77). During the descending phase, the front-LPD showed a more lateral centroid of the latissimus dorsi (ES = 0.60), the biceps brachii (ES = 0.63) and the triceps brachii (ES = 0.98), while the centroid was more medial for the middle trapezius (ES = 0.58). The centroid of the middle trapezius was also more medial in the front-LPD during the ascending phase (ES = 0.85). The pectoralis major centroid was more cranial in the front-LPD for both the descending (ES = 1.58) and the ascending phase (ES = 0.88). The front-LPD appears to provide overall greater excitation in the prime movers. However, distinct spatial excitation patterns were observed, making exercise suitable for the training routine.
PubMed: 38689585
DOI: 10.5114/jhk/185211 -
BMC Musculoskeletal Disorders Apr 2024Rheumatoid arthritis (RA) is an autoimmune disease.However, there are few cases of Charcot Neuro-osteoarthropathy (CN) caused by rheumatoid diseases in clinical reports....
BACKGROUND
Rheumatoid arthritis (RA) is an autoimmune disease.However, there are few cases of Charcot Neuro-osteoarthropathy (CN) caused by rheumatoid diseases in clinical reports. It is not easy to pay attention to the diagnosis of CN in the complications of rheumatoid disease, which greatly increases the probability of misdiagnosis and missed diagnosis. This case reported a rare complication of rheumatoid arthritis, Charcot arthritis, and the molecular mechanism and diagnosis and treatment of CN caused by RA were systematically discussed.
CASE PRESENTATION
The patient, a 79-year-old woman, was hospitalized due to bilateral shoulder pain, limited activity for half a year, aggravated for 4 months to the hospital. During this period, the symptoms did not improve after treatment with acupuncture and Chinese medicine. The patient was previously diagnosed with rheumatoid arthritis for more than 3 years and intermittent irregular use of methylprednisolone and methotrexate for 2 years. She had a history of osteoporosis.
PHYSICAL EXAMINATION
symmetrical malformed swelling of the finger joints of both hands; Bilateral supraspinatus and deltoid muscle atrophy, tenderness at the acromion, and attachment of the long head tendon of the biceps brachii were observed. The left Dugas test and the right Dugas test were positive.Blood test: anti-cyclic citrullinated peptide antibody (A-CCP) 33.10U/ml (normal range: 0-5RU/ml); antinuclear antibody quantification (ANA) 47.40AU/ml (normal range: Negative or < 32); anti-double stranded DNA IgG antibody quantification (dsDNA) 31.00 IU/ml (normal range: 0-100 IU/ml); D-Dimer 6.43 µg/ml (normal range: 0-0.5 mg/L); erythrocyte sedimentation rate (ESR) was 27 mm/h (normal range: < 20 mm/60 min). C-reactive protein (CRP) 39.06 mg/L(0.068-8 mg/L).MRI 3.0 T enhancement of bilateral shoulder joints, cervical spine and thoracic spine showed: 1.Large bone destruction, cartilage injury, multiple effusion, synovitis, obvious on the right side. 2.Intervertebral disc degeneration, cervical 3/4, 4/5, 5/6, 6/7 disc herniation, with cervical 3/4 obvious, posterior central herniation; CONCLUSIONS: Rheumatoid arthritis complicated with Charcot's joint is rare. Clinically, patients with rheumatoid diseases should not ignore Charcot's joint complications because of rareness. Early blood inflammatory markers, neuro electrophysiology, and imaging MRI of rheumatoid CN are of great significance for the diagnosis of this mild or early neurovascular inflammation. Early diagnosis and treatment are helpful to prevent further joint injury. The clinical diagnosis, treatment, and molecular mechanism of osteolysis in RA and peripheral sensory nerve injury remain to be further revealed.
Topics: Humans; Arthritis, Rheumatoid; Female; Aged; Arthropathy, Neurogenic
PubMed: 38685038
DOI: 10.1186/s12891-024-07424-y -
Cureus Mar 2024Adhesive capsulitis following vaccination is a rare complication secondary to improper intramuscular (IM) deltoid vaccine administration. It is considered a subset of...
Adhesive capsulitis following vaccination is a rare complication secondary to improper intramuscular (IM) deltoid vaccine administration. It is considered a subset of the broad category known as shoulder injury related to vaccine administration (SIRVA). SIRVA typically results from improper shoulder anatomic localization prior to injection, leading to erroneous placement of the needle into the glenohumeral joint capsule or subacromial space. This can trigger a wide array of pathologies, including adhesive capsulitis. We present the first known case of adhesive capsulitis following improper tetanus-diphtheria (Td) vaccine administration. The patient, a previously healthy middle-aged female, began experiencing significant anterior left shoulder pain the day following a Td booster vaccination. She remarked receiving the injection "higher up" in the shoulder than normal. Over the next two weeks, she began noting significant shoulder stiffness, which was followed by a progressive loss of shoulder range of motion. Her symptoms persisted for four months without definitive diagnosis or treatment. After four months of symptoms, the patient visited an outpatient sports medicine clinic where the diagnosis of adhesive capsulitis was made. Although the patient was referred for physical therapy, focusing on gentle range of motion (ROM) and stretches, followed by a planned isometric strengthening program once ROM improved, she was eventually lost to follow-up, and her recovery is unclear. Given the rarity of the diagnosis, it is unclear if adhesive capsulitis, secondary to improper IM vaccination, follows the same temporal course as "classic" adhesive capsulitis or results in a different timeframe of recovery. Further studies are needed on this subject.
PubMed: 38681273
DOI: 10.7759/cureus.57113 -
Journal of Clinical Anesthesia Sep 2024The objective of this anatomical study was to investigate the distribution of a solution administered using the Clavipectoral Fascia Plane Block (CPB) technique in a... (Observational Study)
Observational Study
STUDY OBJECTIVE
The objective of this anatomical study was to investigate the distribution of a solution administered using the Clavipectoral Fascia Plane Block (CPB) technique in a series of cadaveric models with midshaft clavicular fractures. The study aimed to address the knowledge gap regarding the impact of clavicular fractures on the distribution pattern of the CPB-administered solution.
DESIGN
Observational cadaveric study.
SETTING
The research was conducted in the laboratory setting of the University of Barcelona, adhering to the institution's ethical guidelines and standards.
PATIENTS
Five unembalmed human cadavers were used, generating ten clavicle samples.
INTERVENTIONS
A postmortem fracture was induced in the middle third of the clavicle using a blunt-edged hammer, simulating a midshaft clavicular fracture.
MEASUREMENTS
Anatomical dissection was performed in three layers: the superficial muscle plane, deep muscle plane, and clavicular periosteum plane. Dye staining with methylene blue was utilized to assess the distribution pattern.
MAIN RESULTS
In the superficial muscular plane, methylene blue was observed in the deltoid (100%), pectoralis major (100%), sternocleidomastoid (SCM) (70%), and trapezius muscles (100%). Conversely, the deep muscular plane, including the subclavius muscle, pectoralis minor, and Clavipectoral Fascia (CPF), exhibited no staining. At the clavicular periosteum plane, methylene blue distributed predominantly to the antero-superior region (57.3%), with a minimal impact on the postero-inferior area (6.5%).
CONCLUSIONS
The study reveals that the presence of a midshaft clavicular fracture does not significantly alter the diffusion pattern of the CPB-administered solution, maintaining a consistent distribution in both intact and fractured clavicle models.
Topics: Humans; Clavicle; Cadaver; Fractures, Bone; Nerve Block; Fascia; Male; Aged; Anesthetics, Local; Female; Methylene Blue; Aged, 80 and over; Muscle, Skeletal; Dissection
PubMed: 38678917
DOI: 10.1016/j.jclinane.2024.111469