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Journal of Rehabilitation Medicine Aug 2023Post-stroke shoulder pain is a serious challenge for stroke survivors. The aim of this meta-analysis was to review the literature to confirm information on structural... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Post-stroke shoulder pain is a serious challenge for stroke survivors. The aim of this meta-analysis was to review the literature to confirm information on structural changes in post-stroke shoulders detected by ultrasound examination.
METHODS
PubMed, Embase, Web of Science and ClinicalTrials.gov were searched until 7 December 2022, for studies describing shoulder sonographic findings in stroke patients. Two independent authors selected the studies, extracted the data, and performed the critical appraisal.
RESULTS
A total of 23 clinical studies were included. The most prevalent pathologies in hemiplegic shoulders pertained to the biceps long head tendon (41.4%), followed by the supraspinatus tendon (33.2%), subdeltoid bursa (29.3%), acromioclavicular joint (15.0%), and subscapularis tendon (9.2%). The common pathological findings encompassed bicipital peritendinous effusion (39.2%), biceps tendinopathy (35.5%), subdeltoid bursitis (29.3%) and supraspinatus tendinopathy (24.6%). Biceps long head tendon and supraspinatus tendon abnormalities were observed significantly more in the hemiplegic (vs contralateral) shoulders, with odds ratios of 3.814 (95% confidence interval 2.044-7.117) and 2.101 (95% confidence interval 1.257-3.512), respectively. No correlation was observed between motor function and shoulder pathology.
CONCLUSION
Ultrasonography enabled the identification of common shoulder pathologies after stroke. Further research is needed to establish the association between these changes and the clinical course of stroke patients.
Topics: Humans; Shoulder; Hemiplegia; Rotator Cuff; Tendons; Bursitis; Pain
PubMed: 37615388
DOI: 10.2340/jrm.v55.13432 -
BMC Musculoskeletal Disorders Apr 2021Obtaining and maintaining final shoulder balance after the entire treatment course is essential for early-onset scoliosis (EOS) patients. The relatively small number of...
BACKGROUND
Obtaining and maintaining final shoulder balance after the entire treatment course is essential for early-onset scoliosis (EOS) patients. The relatively small number of growing-rod (GR) graduates who complete final fusion has resulted in an overall paucity of research on the GR treatment of EOS and a lack of research on the shoulder balance of EOS patients during GR treatment.
METHODS
Twenty-four consecutive patients who underwent GR treatment until final fusion were included. Radiographic shoulder balance parameters, including the radiographic shoulder height (RSH), clavicle angle (CA), and T1 tilt angle (T1T), before and after each step of the entire treatment were measured. Shoulder balance changes from GR implantation to the last follow-up after final fusion were depicted and analysed. Demographic data, surgical-related factors, and radiographic parameters were analysed to identify risk factors for final shoulder imbalance. The shoulder balance of patients at different time points was further analysed to explore the potential effect of the series of GR treatment steps on shoulder balance.
RESULTS
The RSH showed substantial improvement after GR implantation (P = 0.036), during the follow-up period after final fusion (P = 0.021) and throughout the entire treatment (P = 0.011). The trend of change in the CA was similar to that of the RSH, and the T1T improved immediately after GR implantation (P = 0.037). Further analysis indicated that patients with shoulder imbalance before final fusion showed significantly improved shoulder balance after fusion (P = 0.045), and their RSH values at early postfusion and the final follow-up did not show statistically significant differences from those in the prefusion shoulder balance group (P > 0.05). Early postfusion shoulder imbalance (odds ratio (OR): 19.500; 95% confidence interval (CI) = 1.777-213.949; P = 0.015) was identified as an independent risk factor for final shoulder imbalance.
CONCLUSIONS
Shoulder balance could be improved by GR implantation but often changes during the multistep lengthening process, and the final result is relatively unpredictable. Final fusion could further adjust the prefusion shoulder imbalance. Focusing on the prefusion shoulder balance of GR graduates and providing patients with early shoulder balance after fusion might be necessary.
Topics: Follow-Up Studies; Humans; Postural Balance; Retrospective Studies; Scoliosis; Shoulder; Spinal Fusion; Thoracic Vertebrae; Treatment Outcome
PubMed: 33853576
DOI: 10.1186/s12891-021-04221-9 -
Journal of ISAKOS : Joint Disorders &... Sep 2021Venous thromboembolism (VTE) is a rare yet known complication of shoulder surgery. Concerning shoulder arthroplasty, reported rates of VTE range from 0.2% to 16%. Unlike... (Review)
Review
Venous thromboembolism (VTE) is a rare yet known complication of shoulder surgery. Concerning shoulder arthroplasty, reported rates of VTE range from 0.2% to 16%. Unlike many lower extremity procedures, particularly total hip and knee arthroplasty, chemical prophylactic guidelines for VTE in shoulder surgeries have not been established. Some argue that doing so is unnecessary. On the contrary, mechanical prophylaxis is nearly universally accepted in shoulder surgery, particularly for more lengthy procedures. With limited VTE incidence in shoulder surgery, treatment is anecdotally derived from the hip and knee arthroplasty literature. Recent studies have successfully identified risk factors for VTE related to the patient and to the surgery itself. Awareness of these risk factors by the surgeon and declaration of these factors to the patient should be discussed as part of the informed consent process. Further investigational studies and larger patient cohorts will be necessary to optimise VTE prevention in shoulder surgeries.
Topics: Arthroplasty, Replacement, Knee; Humans; Incidence; Risk Factors; Shoulder; Venous Thromboembolism
PubMed: 34535553
DOI: 10.1136/jisakos-2020-000538 -
International Orthopaedics Dec 2020Joint replacement affects the proprioception, as shown in knees, elbows, and shoulder studies.
UNLABELLED
Joint replacement affects the proprioception, as shown in knees, elbows, and shoulder studies.
AIM
The aim was to evaluate shoulder joint position sense (JPS) following reverse total shoulder arthroplasty (rTSA) for patients with cuff arthropathy.
METHODS
Twenty-nine patients that underwent unilateral rTSA (19 females, 10 males) and 31 healthy volunteers evaluated for JPS of shoulder using a dedicated high accuracy electronic goniometer. Error of active reproduction of joint position (EARJP) was assessed at the following reference positions: 30°, 60°, 90°, and 120° for forward flexion and abduction and 15°, 30°, and 45° for internal and external rotation in rTSA, contralateral non-operated, and control shoulders.
RESULTS
Results of EPRJP for rTSA, contralateral, and control (respectively) are as follows:Forward flexion: 30° = (8.0 ± 5.7, 9.8 ± 6.1, and 4.9 ± 3.0), 60° = (5.0 ± 2.8, 5.9 ± 2.7, and 5.1 ± 3.2), 90° = (3.1 ± 1.6, 5.5 ± 2.6, and 3.2 ± 1.4), and 120° = (3.4 ± 2.1, 5.6 ± 4.0, and 3.5 ± 1.7)Abduction: 30° = (5.2 ± 2.5, 9.1 ± 6.1, and 4.6 ± 2.3), 60° = (5.2 ± 3.6, 6.6 ± 4.1, and 5.3 ± 3.1), 90° = (3.8 ± 2.0; 7.4 ± 5.5, and 4.1 ± 1.9), and 120° = (5.3 ± 2.9, 7.7 ± 5.3, and 4.2 ± 1.9)Internal rotation: 15° = (4.3 ± 3.1, 6.2 ± 4.4, and 2.8 ± 1.2), 30° = (3.2 ± 1.9, 4.5 ± 2.3, and 3.3 ± 1.4), and 45° = (3.5 ± 2.0, 4.1 ± 1.8, and 2.8 ± 1.0)External rotation: 15° = (3.0 ± 1.7, 4.2 ± 2.2, and 3.6 ± 1.4) and 30° = (3.1 ± 1.5, 3.8 ± 2.6, and 3.4 ± 1.6)The results showed significantly better JPS (lower EPRJP) in shoulders following rTSA and normal control shoulders comparing with the patient's contralateral shoulder. The explanation can be that rTSA improves joint kinematics and stability, which allows better muscular performance and proprioception feedback.
CONCLUSION
Shoulders following rTSA show JPS superior to non-operated contralateral shoulders and comparable with healthy population shoulders. It seems that rTSA restores shoulder proprioception.
Topics: Arthroplasty, Replacement, Shoulder; Female; Humans; Male; Proprioception; Range of Motion, Articular; Shoulder; Shoulder Joint
PubMed: 32803357
DOI: 10.1007/s00264-020-04756-x -
BMC Musculoskeletal Disorders Jun 2022The aim of this study is to evaluate both the utility of MRI scans and reports used in the current practice routine of shoulder surgeons and their surgical...
BACKGROUND
The aim of this study is to evaluate both the utility of MRI scans and reports used in the current practice routine of shoulder surgeons and their surgical decision-making process.
METHODS
Ninety-three shoulder-specialised orthopaedic surgeons of the Canadian Shoulder and Elbow Society (CSES) Orthopaedic Association were surveyed in 2020 anonymously online to help identify the use of MR-imaging and reports in managing shoulder disorders and surgical decision process.
RESULTS
Thirty out of 93 (32.25%) CSES fellowship-trained orthopaedic surgeons participated. Respondents request MRI scans in about 55% of rotator cuff (RC) pathology and 48% of shoulder instability cases. Fifty percent of patients with potential RC pathology arrive with a completed MRI scan prior first orthopaedic consult. Their surgical decision is primarily based on patient history (45-55%) and physical examination (23-42%) followed by MRI scan review (2.6-18%), reading MRI reports (0-1.6%) or viewing other imaging (3-23%) depending on the shoulder disease. Ninety percent of surgeons would not decide on surgery in ambiguous cases unless the MR-images were personally reviewed. Respondents stated that shoulder MRI scans are ordered too frequently prior specialist visit as identified in more than 50% of cases depending on pathology.
CONCLUSIONS
The decision-making process for shoulder surgery depends on the underlying pathology and patient history. The results demonstrate that orthopaedic surgeons are comfortable reviewing shoulder MRI scans without necessarily reading the MRI report prior to a surgical decision. MRI scans are becoming an increasingly important part of surgical management in shoulder pathologies but should not be used without assessment of patient history and or physical examination.
Topics: Canada; Decision Making; Humans; Joint Instability; Magnetic Resonance Imaging; Rotator Cuff Injuries; Shoulder; Shoulder Joint
PubMed: 35717178
DOI: 10.1186/s12891-022-05541-0 -
La Medicina Del Lavoro Aug 2017Work-related musculoskeletal disorders (WRMDs) interfere with workers' productivity and quality of life. Thus, early detection of disabilities caused by WRMDs is vital... (Review)
Review
UNLABELLED
Work-related musculoskeletal disorders (WRMDs) interfere with workers' productivity and quality of life. Thus, early detection of disabilities caused by WRMDs is vital for preventing the aggravation of symptoms. Early detection aids and is aided by educational and preventive programs. WRMDs can be detected using the Disabilities of the Arm, Shoulder and Hand (DASH) Scale.
OBJECTIVES
The present study aimed to review the literature on the application of the DASH Scale through a consideration of the cultural adaptation process and an evaluation of the scale's psychometric properties.
METHODS
The literature review was conducted using the terms "disabilities", "musculoskeletal disorders", "DASH" "questionnaire" and "upper limbs".
RESULTS
Forty-eight articles were collected, and these included only articles available in English which contained the full version of the DASH Scale and which focused on the evaluation of its psychometric properties (n=25).
CONCLUSION
Most of the studies partially evaluated the psychometric properties of the DASH instrument; however, these properties were typically evaluated using only a correlation analysis involving other instruments.
Topics: Arm; Disability Evaluation; Hand; Humans; Shoulder
PubMed: 28853432
DOI: 10.23749/mdl.v108i4.6336 -
Folia Morphologica 2022Due to its many variations, the scapula is among the most frequently examined bones. Especially the acromion can be of different shapes and sizes. Measurements of the...
BACKGROUND
Due to its many variations, the scapula is among the most frequently examined bones. Especially the acromion can be of different shapes and sizes. Measurements of the morphometric structures in the shoulder joint make it easier to explain the cause of the various shoulder problems. The objective of this study is putting emphasis on the importance of acromion types, os acromiale presence and acromial morphometric measurements in the aetiology and diagnosis of shoulder pain.
MATERIALS AND METHODS
A retrospective study, based on 100 patients of both genders who presented with the complaints of shoulder pain and underwent magnetic resonance imaging, was conducted. Within this scope, types of acromion, slope of acromion, length of acromion, length of coracoid process, the distance between acromion and coracoid process, lateral acromial angle (LAA), critical shoulder angle (CSA), acromial index (AI) and acromiohumeral distance were measured. The data were analysed considering the gender and acromion types and the presence of os acromiale is investigated.
RESULTS
The most common acromion was type II (curved) (frequency rate 62%) while the rate of type I (flat) and type III (hooked) acromions were 21% and 17%, respectively. The length of acromion and coracoid process were found to be significantly longer in males, while no significant difference between genders in terms of the distance between acromion and coracoid process were observed. Furthermore, while negative correlation between LAA and AI as well as LAA and CSA were observed; positive correlation between AI and CSA was found. In addition, there was negative correlation between slope of acromion and acromiohumeral distance. Besides, acromiohumeral distance was significantly higher in males. Regarding the presence of os acromiale, it was observed in 3 women out of 59 and 2 men out of 41, which indicated no significant difference between genders.
CONCLUSIONS
It is evaluated that the morphometric measurement is of importance in contributing clinically in distinguishing the problems that may occur according to gender and acromion types.
Topics: Female; Humans; Male; Shoulder; Retrospective Studies; Shoulder Pain; Acromion; Scapula
PubMed: 34545562
DOI: 10.5603/FM.a2021.0087 -
Anesthesiology Jul 2017Regional anesthesia has an established role in providing perioperative analgesia for shoulder surgery. However, phrenic nerve palsy is a significant complication that... (Review)
Review
Regional anesthesia has an established role in providing perioperative analgesia for shoulder surgery. However, phrenic nerve palsy is a significant complication that potentially limits the use of regional anesthesia, particularly in high-risk patients. The authors describe the anatomical, physiologic, and clinical principles relevant to phrenic nerve palsy in this context. They also present a comprehensive review of the strategies for reducing phrenic nerve palsy and its clinical impact while ensuring adequate analgesia for shoulder surgery. The most important of these include limiting local anesthetic dose and injection volume and performing the injection further away from the C5-C6 nerve roots. Targeting peripheral nerves supplying the shoulder, such as the suprascapular and axillary nerves, may be an effective alternative to brachial plexus blockade in selected patients. The optimal regional anesthetic approach in shoulder surgery should be tailored to individual patients based on comorbidities, type of surgery, and the principles described in this article.
Topics: Anesthesia, Conduction; Humans; Paralysis; Phrenic Nerve; Shoulder
PubMed: 28514241
DOI: 10.1097/ALN.0000000000001668 -
Journal of Orthopaedic Research :... Oct 2022The Patient-Reported Outcomes Measurement Information System Upper Extremity Computer Adaptive Test (PROMIS UE CAT) is a newer patient-reported outcome measure for upper...
The Patient-Reported Outcomes Measurement Information System Upper Extremity Computer Adaptive Test (PROMIS UE CAT) is a newer patient-reported outcome measure for upper extremity physical function. To date, no longitudinal study exists assessing PROMIS UE CAT responsiveness in patients undergoing shoulder arthroplasty. The purpose of this prospective longitudinal study is to report PROMIS UE CAT responsiveness to change and correlation to legacy instruments in patients undergoing total shoulder arthroplasty (TSA). Ninety-six patients (97 shoulders) undergoing TSA completed the PROMIS UE, Oxford Shoulder Score (OSS), American Shoulder and Elbow Surgeons (ASES), and Simple Shoulder Test (SST) preoperatively and postoperatively at 6 weeks, 12 weeks, and after 6 months. Spearman's correlation coefficients (r) were calculated between PROMIS UE and other scores at each time-point. Responsiveness to change was assessed using the effect size (Cohen's d) and standardized response mean compared with the preoperative time-point. Floor and ceiling effects were also assessed. PROMIS UE CAT demonstrated positive responsiveness at all time-points after TSA. It demonstrated excellent correlation (range: 0.68-0.84) with ASES, SST, and OSS at all postoperative time-points, but the correlation was weaker (r < 0.6, except OSS) preoperatively. Only OSS and SST showed ceiling effects at the 6-12-month time-point (16.8% and 18.2%, respectively). PROMIS UE CAT responsiveness to change and strength of correlation with legacy instruments improves with time elapsed after TSA. Further quantification of meaningful responsiveness to change will require estimation of the minimal clinically important difference and substantial clinical benefit for PROMIS UE CAT.
Topics: Arthroplasty, Replacement, Shoulder; Patient Reported Outcome Measures; Prospective Studies; Shoulder; United States
PubMed: 35060155
DOI: 10.1002/jor.25263 -
Orthopaedics & Traumatology, Surgery &... Feb 2020One-stage exchange is the gold-standard for management of periprosthetic shoulder infection. The present review compares efficacy between 1- and 2-stage exchange in this... (Review)
Review
INTRODUCTION
One-stage exchange is the gold-standard for management of periprosthetic shoulder infection. The present review compares efficacy between 1- and 2-stage exchange in this indication.
MATERIAL AND METHODS
We performed a systematic literature review and meta-analysis following the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) criteria. The literature search used the Medline, Embase and Central data-bases. The studies included assessed 1- and 2-stage exchange in periprosthetic shoulder infection. The main outcome was reinfection rate, and the secondary outcome postoperative complications rate.
RESULTS
Twenty-one studies, for 501 patients, were included: 5 assessing 1-stage exchange, 11 2-stage, and 5 both. Mean follow-up was 4.3 years (range, 2-6.1 years). Mean reinfection rates ranged between 0 and 50% in 1-stage exchange and between 0 and 36.8% in 2-stage exchange. The combined rate was 7% (95% CI, 3.8-12.5%) in 1-stage and 21.3% (95% CI, 16-27.9%) in 2-stage exchange. Mean complications rates ranged between 0 and 50% in 1-stage exchange and between 5.7% and 73%% in 2-stage exchange. The combined rate was 17% (95% CI, 11.9-23.9%) in 1-stage and 32.8% (95% CI, 25.8-40.6%) in 2-stage exchange.
DISCUSSION
To our knowledge, the present meta-analysis is the first to assess results in 1- and 2-stage exchange for chronic periprosthetic shoulder infection.
CONCLUSION
One-stage exchange seemed to provide better results, with less reinfection and fewer complications than 2-stage exchange.
LEVEL OF EVIDENCE
I, meta-analysis.
Topics: Humans; Postoperative Complications; Prosthesis-Related Infections; Shoulder
PubMed: 31862323
DOI: 10.1016/j.otsr.2019.10.016