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Tazawa T, Yasui M, Otsuka S, Hatayama N, Naito M, Ohshima S, Yokota H. Development of a musculoskeletal shoulder model considering anatomic joint structures and soft-tissue deformation for dynamic simulation. Anat Sci Int 2024; 99:278-289. [PMID: 38698275 DOI: 10.1007/s12565-024-00773-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
The shoulder joint has a high degree of freedom and an extremely complex and unstable kinematic mechanism. Coordinated contraction of the rotator cuff muscles that stop around the humeral head and the deltoid muscles and the extensibility of soft tissues, such as the joint capsule, labrum, and ligaments, contribute to shoulder-joint stability. Understanding the mechanics of shoulder-joint movement, including soft-tissue characteristics, is important for disease prevention and the development of a device for disease treatment. This study aimed to create a musculoskeletal shoulder model to represent the realistic behavior of joint movement and soft-tissue deformation as a dynamic simulation using a rigid-body model for bones and a soft-body model for soft tissues via a spring-damper-mass system. To reproduce the muscle-contraction properties of organisms, we used a muscle-expansion representation and Hill's mechanical muscle model. Shoulder motion, including the movement of the center of rotation in joints, was reproduced, and the strain in the joint capsule during dynamic shoulder movement was quantified. Furthermore, we investigated narrowing of the acromiohumeral distance in several situations to induce tissue damage due to rotator cuff impingement at the anterior-subacromial border during shoulder abduction. Given that the model can analyze exercises under disease conditions, such as muscle and tendon injuries and impingement syndrome, the proposed model is expected to help elucidate disease mechanisms and develop treatment guidelines.
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Affiliation(s)
- Taku Tazawa
- Department of Mechanical Engineering, Meijo University, 1-501 Shiogamaguchi, Tempaku-Ku, Nagoya-Shi, Aichi, Japan
- ASAHI INTECC CO., LTD., Aichi, Japan
| | - Masaya Yasui
- Department of Judo Seifuku and Health Sciences, Tokoha University, 1230 Miyakodacho, Kita-ku, Hamamatsu-shi, Shizuoka, Japan
| | - Shun Otsuka
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute-shi, Aichi, Japan
| | - Naoyuki Hatayama
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute-shi, Aichi, Japan
| | - Munekazu Naito
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute-shi, Aichi, Japan
| | - Shigemichi Ohshima
- Department of Mechanical Engineering, Meijo University, 1-501 Shiogamaguchi, Tempaku-Ku, Nagoya-Shi, Aichi, Japan
| | - Hiroki Yokota
- Department of Mechanical Engineering, Meijo University, 1-501 Shiogamaguchi, Tempaku-Ku, Nagoya-Shi, Aichi, Japan.
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Mi Y, Lin Y, Cheng B. Magnetic resonance imaging based coracoid process morphology and its associations with isolated subscapularis tendon tears in Chinese patients. Jt Dis Relat Surg 2024; 35:267-275. [PMID: 38727104 PMCID: PMC11128975 DOI: 10.52312/jdrs.2024.1587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/17/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVES This study aims to assess the association between isolated subscapularis tears and coracoid morphology using magnetic resonance imaging (MRI) and to calculate the optimal cut-off values of the significant predictor to predict subscapularis tears. PATIENTS AND METHODS Between January 2018 and December 2022, a total of 60 patients (29 males, 31 females; mean age: 58.4±8.4 years; range, 18 to 80 years) diagnosed with subscapularis tendon tears who were treated as Group A and 60 patients (29 males, 31 females; mean age: 46.8±11.5 years; range, 18 to 80 years) without subscapularis tendon tears who were treated as Group B were included. Axial coracoid-humeral distance (aCHD), sagittal coracoid-humeral distance (sCHD), coracoid overlap (CO) and coracoid angle (CA) of all patients were measured. Logistic regression was used to investigate the association between subscapularis tears as variables including aCHD, sCHD, CO and CA. Receiver operating characteristic curve analysis was used to determine the diagnostic values of coracoid morphology for subscapularis tears. RESULTS The mean values of CO, aCHD and sCHD in Group A were 22.16 mm, 5.13 mm, and 5.56 mm, respectively. The mean values in Group B were 16.99 mm, 7.18 mm, and 7.29 mm, respectively. The degree of CA in Group A was 95.81 and 111.69 in Group B. The differences in the above measurement values were significant between two Groups. The CO was found to be associated with higher odds of subscapularis tears. The optimal cut-off value of CO was 19.79 mm. CONCLUSION Based on our study results, CO is positively associated with isolated subscapularis tears. In addition, coracoid bursa effusion, cysts in the lesser tuberosity or a tear and malposition of long head of the biceps tendon on MRI may predict the presence of a clinically significant subscapularis tear.
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Affiliation(s)
| | | | - Biao Cheng
- School of Medicine Tongji University, Department of Orthopedics, Tongji Hospital of Tongji University, Shanghai 200065, China.
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Abu El Kasem ST, Alaa FAA, Abd El-Raoof NA, Abd-Elazeim AS. Efficacy of Mulligan thoracic sustained natural apophyseal glides on sub-acromial pain in patients with sub-acromial impingement syndrome: a single-blinded randomized controlled trial. J Man Manip Ther 2024:1-10. [PMID: 38618993 DOI: 10.1080/10669817.2024.2341453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/05/2024] [Indexed: 04/16/2024] Open
Abstract
PURPOSE To investigate the effects of Mulligan thoracic sustained natural apophyseal glides (SNAGS) techniques and traditional exercises on pain, shoulder function, size of sub-acromial space, and shoulder joint range in patients with sub-acromial impingement syndrome. METHODS Seventy-four patients with sub-acromial impingement syndrome (25 to 40 years) joined this research and were allocated randomly into two equal groups; experimental group A (Mulligan SNAGS and exercise) and control group B (exercise only). All patients were assessed by visual analogue scale (VAS) for pain intensity, Shoulder Pain and Disability Index (SPADI) for shoulder function, plain x-ray for the size of sub-acromial space, and goniometer for shoulder range of motion (ROM). The measurements were performed at two intervals (baseline and after four weeks of intervention). RESULTS After 4 weeks of intervention, there were statistically significant differences between groups, in favor of Mulligan SNAGS, on sub acromial space size, pain intensity, shoulder function, and shoulder joint range of motion (p < 0.05). In within-group analysis, there were also statistically significant differences between pre- and post-treatment in all measured variables (p < 0.05). CONCLUSION Mulligan thoracic spine (SNAGS) mobilization into extension and traditional exercises improve sub acromial space size, pain intensity, shoulder function, and shoulder joint range of motion in patients with sub acromial impingement syndrome. It is recommended to mobilize the thoracic spine by mulligan SNAGS in the treatment of sub-acromial impingement syndrome.
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Affiliation(s)
- Shimaa T Abu El Kasem
- Department of Basic Science, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Basic Science, Faculty of Physical Therapy, Galala University, Suez, Egypt
| | - Fatma Alzahraa A Alaa
- Department of Basic Science, Faculty of Physical Therapy, 6th October University, Giza, Egypt
| | - Neveen A Abd El-Raoof
- Department of Basic Science, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Lee K, Kim JH, Hong H, Jeong Y, Ryu H, Kim H, Lee SU. Deep learning model for classifying shoulder pain rehabilitation exercises using IMU sensor. J Neuroeng Rehabil 2024; 21:42. [PMID: 38539223 PMCID: PMC10967210 DOI: 10.1186/s12984-024-01343-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/15/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Artificial intelligence is being used for rehabilitation, including monitoring exercise compliance through sensor technology. AI classification of shoulder exercise wearing an IMU sensor has only been reported in normal (i.e. painless) subjects. To prove the feasibility of monitoring exercise compliance, we aimed to classify 11 types of shoulder rehabilitation exercises using an AI (artificial intelligence) algorithm in patients with shoulder pain. We had the patients wear an IMU-based sensor, collected data during exercise, and determined the accuracy of exercise classification. METHODS Data were collected from 58 patients (27 males, 31 females, age range 37-82 years) diagnosed with shoulder diseases such as adhesive capsulitis and rotator cuff disease. 11 types of shoulder pain rehabilitation exercise programs were developed and repeated each exercise ten times per session while wearing an IMU sensor. The study applied the Rectified Linear Unit (ReLU) and the SoftMax as the activation function for hidden layers, the output layer. RESULTS The acquired data was used to train a DNN model using the multilayer perceptron algorithm. The trained model was used to classify 11 types of shoulder pain rehabilitation exercises. The training accuracy was 0.975 and the test accuracy was 0.925. CONCLUSION The study demonstrates that IMU sensor data can effectively classify shoulder pain rehabilitation exercises, providing more appropriate feedback for patients. The model can be utilized to establish a system for remotely monitoring patients' exercise performance. The use of deep learning in patient monitoring and rehabilitation has significant potential to bring innovative changes to healthcare service delivery.
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Affiliation(s)
- Kyuwon Lee
- Dept. of Rehabilitation Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Jeong-Hyun Kim
- Dept. of Rehabilitation Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Hyeon Hong
- Dept. of Rehabilitation Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Yeji Jeong
- Dept. of Rehabilitation Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Hokyoung Ryu
- Dept. of Graduate School of Technology and Innovation Management, Hanyang University, Seoul, South Korea
| | - Hyundo Kim
- Dept. of Intelligence Computing, Hanyang University, Seoul, South Korea
| | - Shi-Uk Lee
- Dept. of Rehabilitation Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea.
- Dept. of Physical Medicine & Rehabilitation, College of Medicine, Seoul National University, Seoul, South Korea.
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Greif DN, Shaikh HJ, Neumanitis J, Ramirez G, Maloney MD, Bronstein RD, Giordano B, Nicandri GT, Voloshin I, Mannava S. Arthroscopic subacromial decompression improved outcomes in situationally depressed patients compared to clinically depressed or nondepressed patients. JSES Int 2024; 8:304-309. [PMID: 38464455 PMCID: PMC10920123 DOI: 10.1016/j.jseint.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Background The purpose of this study is to evaluate patient reported outcomes after arthroscopic extensive débridement of the shoulder with subacromial decompression (SAD) for subacromial impingement using the Patient-Reported Outcomes Measurement Information System (PROMIS) system and evaluate if depression (Dep) (clinical or situational) impacts patients achieving a Minimal Clinically Important Difference (MCID). Methods Preoperative PROMIS Physical function (PF), Mood, and Dep scores were obtained at the closest date prior to arthroscopic rotator cuff repair and postoperative scores were collected at every clinical visit thereafter. Final PROMIS score used for data analysis was determined by the patients final PROMIS value between 90 to 180 days. Clinical Dep was determined by patients having a formal diagnosis of "Depression or Major Depressive Disorder" at the time of their surgery. Situationally depressed patients, those without a formal diagnosis yet exhibited symptomatic depressive symptoms, were classified by having a PROMIS-Dep cutoff scores larger than 52.5. Results A total of 136 patients were included for final statistical analysis. 13 patients had a clinical but not situational diagnosis of Dep, 86 patients were identified who had no instance of clinical or situational Dep (nondepressed). 35 patients were situationally depressed. All three cohorts demonstrated a significant improvement in postoperative PROMIS Dep, PI, and PF score relative to their preoperative value (P = .001). Situationally depressed patients achieved greater delta PROMIS-Dep compared to patients with major depressive disorder. Depressed patients had a higher chance of achieving MCID for PROMIS-Dep compared to nondepressed patients (P = .01). Logistic regression analysis demonstrated that underlying Dep did not alter the odds of obtaining MCID compared to nondepressed patients. Nonsmoking patients had significantly greater odds of achieving MCID for PF (P = .02). Discussion Patients improved after undergoing SAD regardless of underlying Dep or depressive symptoms. Depressed patients exhibited greater change in PROMIS scores compared to nondepressed patients. Smoking remains a risk factor for postoperative outcomes in patients undergoing SAD for subacromial impingement. Identifying and counseling patients with underlying depressive symptoms without a formal major depressive disorder diagnosis may lead to improved outcomes. These findings may help guide clinicians in deciding who would benefit the most from this procedure.
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Affiliation(s)
- Dylan N. Greif
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Hashim J.F. Shaikh
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - James Neumanitis
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Gabriel Ramirez
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Michael D. Maloney
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Robert D. Bronstein
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Brian Giordano
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Gregg T. Nicandri
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Ilya Voloshin
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Sandeep Mannava
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
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Ankar P, Harjpal P. Comparative Analysis of Various Rotator Cuff Stretching Techniques: Efficacy and Recommendations for Gym Enthusiasts. Cureus 2024; 16:e51785. [PMID: 38322067 PMCID: PMC10844772 DOI: 10.7759/cureus.51785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/06/2024] [Indexed: 02/08/2024] Open
Abstract
Shoulder pain is a common complaint among gym-going individuals, particularly those engaged in upper limb workouts. The rotator cuff, comprising four muscles, plays a crucial role in stabilizing the shoulder joint during movements and supporting its mobility. Imbalances or weaknesses in these muscles can lead to shoulder injuries, affecting performance and overall well-being. The main aim of this review is to explore the benefit of one of the approaches in preventing shoulder pain and improving performance among gym-going individuals. Specific rotator cuff stretching exercises target the entire shoulder complex to enhance the mobility, control, and stabilization of the joint. The dynamic warm-up routine will actively engage the relevant muscles in various planes of motion, promoting the increased range of motion and reduced inflammation. Ultimately, the results from this review can serve as important knowledge for gym-going individuals, trainers, and fitness enthusiasts, guiding them in incorporating evidence-based warm-up strategies to optimize their workouts. Empowering individuals to take proactive measures in caring for their shoulder health can lead to improved overall performance and a better training experience in the gym.
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Affiliation(s)
- Prajyot Ankar
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pallavi Harjpal
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Wagan AA, Surahyo P. Un-resolving frozen shoulder: Are we really treating it? Pak J Med Sci 2024; 40:165-169. [PMID: 38196471 PMCID: PMC10772408 DOI: 10.12669/pjms.40.1.7440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/24/2023] [Accepted: 09/20/2023] [Indexed: 01/11/2024] Open
Abstract
Objective To perform ultrasound examination in un-resolving frozen shoulder disorder, in Pakistani cohort visiting rheumatology clinic. Methods This cross sectional study was carried out at Department of Rheumatology, Indus Medical College Tando Mohhamad Khan, from 16th March 2022 to 30th October 2022. Patients diagnosed as unilateral frozen shoulder on clinical grounds and received intra-articular injection (s) in last six months, never been investigated, still persisting with pain and restricted range of shoulder motion were enrolled. After the demographic details and shoulder examination, ultrasound examination of both shoulder joints was performed by senior musculoskeletal radiologist, to know the exact diagnosis. Results In 138 cases on ultrasound examination following injuries were noted: rotator cuff tendinopathy (RCT) (61%), adhesive capsulitis (21%), mixed lesion (rotator cuff tendinopathy and adhesive capsulitis) (14%).In age group < 50 years rotator cuff tendinopathy was the major lesion, while in cases >50 years age group: adhesive capsulitis (AC) was predominant lesion (p-0.05).Rotator cuff tendinopathy had significant association with supraspinatus tears (p<0.5). Conclusion In Un-resolving frozen shoulder pain, ultrasound examination of involved joint helps in reaching the exact cause which may differ from the existing diagnosis and guides to further management.
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Affiliation(s)
- Abrar Ahmed Wagan
- Abrar Ahmed Wagan, MBBS, FCPS (Medicine), FCPS (Rheumatology), FACR. Associate Professor of Rheumatology, Indus Medical College, Tando Mohammad Khan, Pakistan
| | - Paras Surahyo
- Paras Surahyo, MBBS, FCPS (Radiology) Assistant Professor, Department of Radiology, Bilawal Medical College, Jamshoro, Pakistan
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Bensler S. [Subacromial shoulder impingement]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:771-778. [PMID: 37707546 DOI: 10.1007/s00117-023-01209-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/15/2023]
Abstract
Impingement, especially subacromial impingement, is one of the most frequent causes of shoulder pain. It results in soft tissue pathologies due to constriction of the subacromial space. It can lead to tendon pathologies and bursitis. In addition to the clinical examination, imaging methods such as magnetic resonance imaging (MRI), MRI arthrography, ultrasound and X‑ray examinations are helpful in making a diagnosis or evaluating the cause of pain. Conservative treatment approaches, such as rest, medication, physiotherapy, manual therapy and infiltrations should primarily be used. If the symptoms do not improve after 3-6 months of conservative treatment, surgical treatment should be considered.
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Affiliation(s)
- Susanne Bensler
- Institut für Radiologie, Kantonsspital Baden, Im Ergel 1, 5404, Baden, Schweiz.
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Sood A, Kashikar SV, Mishra GV, Parihar P, Khandelwal S, Suryadevara M, Manuja N, Saboo K, Batra N, Ahuja A. The Spectrum of Shoulder Pathologies on Magnetic Resonance Imaging: A Pictorial Review. Cureus 2023; 15:e44801. [PMID: 37809114 PMCID: PMC10558894 DOI: 10.7759/cureus.44801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Patients present to the orthopedic outpatient department with complaints of shoulder pain on movement or restriction of movement in the shoulder joint and are referred for magnetic resonance imaging (MRI) of the shoulder joint. Almost all the patients have similar complaints but may have a wide range of pathology affecting the joint and causing pain. Rotator cuff tears or tendinopathy are the most common causes of shoulder pain. Ultrasound (USG) and MRI are the most commonly used imaging modalities for assessing rotator cuff pathologies. There is a wide range of pathologies affecting the shoulder joint, other than rotator cuff tendinopathies or tears, for which USG is less sensitive and specific in detecting accurate pathology. MRI is the choice of imaging for shoulder joint pathologies. We present a pictorial review discussing and depicting MRI features of a wide list of pathologies of the shoulder joint complex that should be kept in mind when the patient presents with shoulder pain.
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Affiliation(s)
- Anshul Sood
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shivali V Kashikar
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gaurav V Mishra
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratapsingh Parihar
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shreya Khandelwal
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manasa Suryadevara
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nishtha Manuja
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Keyur Saboo
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nitish Batra
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abhinav Ahuja
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Liu S, Liu JT, Chen L, Fan TY, Cui XJ, Cheng SD, Chen YJ, Shi Q, Xue CC, Li XF. Efficacy of five-step shoulder manipulation for rotator cuff-related shoulder pain: protocol for a multicenter randomized controlled trial. Trials 2023; 24:498. [PMID: 37550698 PMCID: PMC10405406 DOI: 10.1186/s13063-023-07540-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 07/25/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Rotator cuff-related shoulder pain (RCRSP) is the most common cause of shoulder disorders. In China, manipulation has been used extensively for the treatment of patients with RCRSP. However, high-quality clinical evidence to support the therapeutic effect of manipulation is still limited. METHODS A multicenter, participant-, outcome assessor-, and data analyst-blinded, randomized, placebo-controlled trial will be conducted. A total of 280 participants with RCRSP will be recruited from three hospitals and randomly assigned to a five-step shoulder manipulation (FSM) group or a sham manipulation (SM) group. Each group will receive four weekly treatment sessions, with all participants performing exercises at home for 12 weeks. Assessments, namely the Constant-Murley score, visual analog scale, range of motion, and 36-Item Short Form Survey, will be made at baseline, 4, 12, 18, and 24 weeks. Adverse events during the study will also be recorded. DISCUSSION This is a pragmatic clinical trial to evaluate the efficacy and safety of FSM in patients with RCRSP. The findings of this study will provide worthy clinical evidence for manual therapy for RCRSP. TRIAL REGISTRATION China Registered Clinical Trial Registration Center ChiCTR2000037577. Registered on 29 August 2020.
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Affiliation(s)
- Shuang Liu
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiangzhong Road, Shanghai, 200071 China
- LongHua Hospital Shanghai University of Traditional Chinese Medicine, 725 Wanpingnan Road, Shanghai, 200032 China
| | - Jin-Tao Liu
- Suzhou Hospital of Traditional Chinese Medicine, 899 Wuzhongxi Road, Suzhou, 215009 Jiangsu China
| | - Lin Chen
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiangzhong Road, Shanghai, 200071 China
| | - Tian-You Fan
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiangzhong Road, Shanghai, 200071 China
| | - Xue-Jun Cui
- LongHua Hospital Shanghai University of Traditional Chinese Medicine, 725 Wanpingnan Road, Shanghai, 200032 China
| | - Shao-Dan Cheng
- Shanghai GuangHua Hospital of Integrated Traditional Chinese and Western Medicine, 540 Xinhua Road, Shanghai, 200052 China
| | - Yan-Jiao Chen
- Shanghai Research Institute of Acupuncture and Meridian, YueYang Hospital of Integrated Traditional Chinese and Western Medicine, 650 Wanpingnan Road, Shanghai, 200030 China
| | - Qi Shi
- LongHua Hospital Shanghai University of Traditional Chinese Medicine, 725 Wanpingnan Road, Shanghai, 200032 China
- Qi Shi’s Studio of Famous Chinese Medicine Physician, 274 Zhijiangzhong Road, Shanghai, 200032 China
| | - Chun-Chun Xue
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiangzhong Road, Shanghai, 200071 China
| | - Xiao-Feng Li
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiangzhong Road, Shanghai, 200071 China
- Qi Shi’s Studio of Famous Chinese Medicine Physician, 274 Zhijiangzhong Road, Shanghai, 200032 China
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Akhtar MJ, Kumar S, Chandan CB, Kumar P, Kumar B, Sinha RR, Kumar A. Morphometry and Morphology of the Acromion Process and Its Implications in Subacromial Impingement Syndrome. Cureus 2023; 15:e44329. [PMID: 37779751 PMCID: PMC10538576 DOI: 10.7759/cureus.44329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Subacromial impingement syndrome (SIS) is a common shoulder disorder characterized by pain and limited range of motion in the shoulder joint. It is frequently attributed to the compression or impingement of the rotator cuff tendons and bursa between the humeral head and the acromion process of the scapula during arm elevation. Subacromial impingement syndrome may arise as a result of the morphology of the acromion process, a bony protrusion at the top of the scapula that is important in the biomechanics of the shoulder joint. In order to detect potential anatomical differences that can predispose people to subacromial impingement syndrome, medical professionals and researchers need to have a thorough understanding of the morphometry and morphology of the acromion process. Aims and objectives The aim of the present study was to measure the morphometric and morphological characteristics of the acromion process in dried human scapulae that belonged to the North Indian population. Materials and methods This was a cross-sectional study that was carried out on 120 undamaged adult human scapula, of which 52 belonged to the right side and 68 belonged to the left side. Our study focused on analyzing the morphology of the acromion process as well as determining its maximum length, maximum breadth, acromio-coracoid distance, acromio-glenoid distance, and thickness. A statistical analysis of the observed parameters was carried out using the chi-square test and independent t-test with the help of Statistical Package for the Social Sciences (SPSS, IBM Corp., Armonk, NY) 24.0. Statistical significance was set at 0.05 (if the P-value ≤ 0.05, it is significant). Results We observed that the quadrangular shape (51.67%) of the acromion process was most commonly reported in our study, while the tubular (9.99%) shape was the least common. The difference in the incidences of various shapes of the acromion process on the right and left sides of the scapula was found to be statistically significant (p-value ≤ 0.05). In this study, the curved or type II acromion process was the most common type (53.34%) observed, while the least common shape reported was the hooked type (18.33%). The average length of the right acromion process was 44.52±6.61 mm, and the left acromion process was 45.13±6.35 mm. For the breadth, the right acromion had an average value of 28.31±4.67 mm, while the left had an average of 28.34±4.92 mm. The thickness of the right acromion measured 7.10±1.73 mm, and the left acromion was 7.53±1.44 mm. The acromio-coracoid distance on the right side was 34.59 ± 6.47 mm, and the left side was 37.46±6.22 mm. The acromio-glenoid distance was measured to be 32.31±5.87 mm on the right side and 33.18±5.39 mm on the left side. Conclusions Planning and carrying out an acromioplasty require an understanding of the morphometric parameters of the acromion process. Although there is a paucity of research on its morphometric evaluation in the North Indian population, the surgeons would be able to use these data as a reference.
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Affiliation(s)
- Md Jawed Akhtar
- Department of Anatomy, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Sanjay Kumar
- Department of Anatomy, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | | | - Prabhat Kumar
- Department of Physical Medicine and Rehabilitation, Nalanda Medical College Hospital, Patna, IND
| | - Binod Kumar
- Department of Anatomy, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Rajiv Ranjan Sinha
- Department of Anatomy, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Avanish Kumar
- Department of Anatomy, Indira Gandhi Institute of Medical Sciences, Patna, IND
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12
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Finas M, Frandon J, Gremen E, Horteur C, Benassayag M, Lateur G, Pailhe R, Ferretti G, Bellier A, Ghelfi J. A Retrospective Comparison of the Efficacy of Embolization with Imipenem/Cilastatin and Microspheres in the Management of Chronic Shoulder Pain. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03385-2. [PMID: 36826491 DOI: 10.1007/s00270-023-03385-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE To compare the efficacy of embolization with imipenem/cilastatin and microspheres in chronic shoulder pain. METHODS This retrospective study included 29 patients who underwent embolization for chronic shoulder pain between June 2017 and March 2022 with calibrated MSs from 100 to 250 µm or IMP/CS. The main objective was the clinical success evaluated by the Minimum Clinically Important Difference (MCID) at 3 months after the procedure, validated if the patient responded yes to 2 questions: (1) Is the pain less severe than before the procedure? (2) Are you satisfied with the procedure? The decrease in visual analogue pain scale scores and the safety of the procedure were evaluated. RESULTS Embolization was achieved in all patients. In the MS group, 4/15 patients (26.7%) experienced clinical success at 3 months according to MCID versus 10/14 patients (71.4%) in the IMP/CS group (p = 0.02). The mean VAS decreases were respectively - 28.6% ± 34.6 in the MS group and - 36.8% ± 27.8 in the IMP/CS group at 1 month (p = 0.50), - 29.9% ± 29.0 and - 39.6% ± 23.0 at 3 months (p = 0.33) and - 30.6% ± 32.8 and - 46.6% ± 28.4 at 6 months after the procedure (p = 0.26). Eleven patients (73.3%) in the MS group and 3 patients (21.4%) in the IMP/CS group had complications (p = 0.01). Among them, 2/15 patients (13.3%) had transient skin ischaemia in the MS group. CONCLUSION Embolization with IMP/CS may be more effective and safer than MSs in the management of chronic shoulder pain.
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Affiliation(s)
- Mathieu Finas
- University of Grenoble-Alpes, Grenoble, France.,Department of Radiology, Grenoble-Alpes University Hospital, Grenoble, France
| | - Julien Frandon
- Department of Radiology, Nimes University Hospital, Nimes, France
| | - Emeric Gremen
- University of Grenoble-Alpes, Grenoble, France.,Department of Radiology, Grenoble-Alpes University Hospital, Grenoble, France
| | - Clément Horteur
- University of Grenoble-Alpes, Grenoble, France.,Department of Orthopaedic Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Michaël Benassayag
- Department of Orthopaedic Surgery, Medipôle de Savoie Hospital, Challes-les-Eaux, France
| | - Gabriel Lateur
- Department of Orthopaedic Surgery Department, Albertville Hospital, Albertville, France
| | - Régis Pailhe
- University of Grenoble-Alpes, Grenoble, France.,Department of Orthopaedic Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Gilbert Ferretti
- University of Grenoble-Alpes, Grenoble, France.,Department of Radiology, Grenoble-Alpes University Hospital, Grenoble, France
| | - Alexandre Bellier
- University of Grenoble-Alpes, Grenoble, France.,Clinical Research Department, Grenoble-Alpes University Hospital, Grenoble, France
| | - Julien Ghelfi
- University of Grenoble-Alpes, Grenoble, France. .,Department of Radiology, Grenoble-Alpes University Hospital, Grenoble, France. .,Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, University of Grenoble-Alpes, Grenoble, France.
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Choi M, Chung J. Biomechanical and functional analysis of the shoulder complex and thoracic spine in patients with subacromial impingement syndrome: A case control study. Medicine (Baltimore) 2023; 102:e32760. [PMID: 36705396 PMCID: PMC9875974 DOI: 10.1097/md.0000000000032760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The motions of the shoulder are mainly carried out through the glenohumeral joint, but are also assisted by the scapulothoracic joint. Therefore, changes in the biomechanics of the thoracic spine and scapula affect the function of the shoulder. However, there is limited information on the biomechanical and functional characteristics of the shoulder complex and thoracic spine in patients with subacromial impingement syndrome (SIS). In this study, the biomechanical and functional characteristics of the shoulder complex and thoracic spine were analyzed in patients with SIS compared to healthy individuals. A total of 108 participants were included in this study. Participants were classified into 2 groups, the SIS (n = 55) and healthy (n = 53) groups. The shoulder and thoracic range of motion (ROM), scapular position, and isokinetic shoulder strength were measured in all participants. The shoulder ROM was significantly decreased in the SIS group compared to the healthy group (P < .001). The thoracic spine ROM showed significantly limited extension in the SIS group (P < .001). The scapular position showed significantly increased anterior tilting (P = .005), internal rotation (P = .032), protraction (P < .001), and decreased upward rotation (P = .002) in the SIS group. The isokinetic shoulder external rotation (P < .001) and abduction (P < .001) strength were significantly lower in the SIS group. Patients with SIS showed reduced shoulder ROM and end-range extension of the thoracic spine compared to healthy individuals, and the scapula was in a more anterior-tilted, protracted, and downward rotated position. In addition, it showed lower external rotation and abduction strength. These results suggest the need for interventions to improve the limited thoracic extension and altered scapular position, which may affect shoulder ROM and muscle strength in the rehabilitation of patients with SIS.
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Affiliation(s)
- Moonyoung Choi
- Department of Sports Science Convergence, Dongguk University, Seoul, Republic of Korea
| | - Jinwook Chung
- Department of Sports Science Convergence, Dongguk University, Seoul, Republic of Korea
- * Correspondence: Jinwook Chung, Department of Sports Science Convergence, Dongguk University, 30, Pildong-ro 1-gil, Jung-gu, Seoul 04620, Republic of Korea (e-mail: )
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14
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Jäschke M, Köhler HC, Weber MA, Tischer T, Hacke C, Schulze C. Subacromial impingement syndrome: association of multiple magnetic resonance imaging parameters with shoulder function and pain. Arch Orthop Trauma Surg 2023; 143:237-246. [PMID: 34231045 PMCID: PMC9886650 DOI: 10.1007/s00402-021-04032-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/23/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Shoulder pain is one of the most common complaints in orthopaedics. This study focusses on the relationship between shoulder function in subacromial impingement syndrome and imaging criteria in magnetic resonance imaging (MRI). MATERIALS AND METHODS This prospective clinical trial included 69 patients treated for subacromial impingement syndrome. Shoulder function (Constant Score, range of abduction, abduction force) and pain were correlated with the following MRI parameters: tendinosis of the rotator cuff, "halo-sign" around the biceps tendon, subacromial distance, critical shoulder angle, size of subacromial osteophytic spurs and maximum width of subacromial and subdeltoid bursa. Statistical analyses included Pearson's and Spearman's coefficients of correlation, multiple regression analysis and Student's t-test. RESULTS The Constant Score was correlated positively with the critical shoulder angle (r = 0.313; p = 0.009) and inversely with a "halo-sign" around the biceps tendon (rho = -0.384; p = 0.001). There was no significant correlation between spur size and shoulder function, but the size of the subacromial and subdeltoid bursae was positively correlated with the subacromial spur's size (subacromial bursa: coronal plane: r = 0.327; p = 0.006; sagittal view: r = 0.305; p = 0.011; subdeltoid bursa coronal view: r = 0.333 p = 0.005). The width of the subdeltoid bursa in coronal plane was positively correlated with shoulder pain (r = 0.248; p = 0.004) and negatively with the range of abduction (r = -0.270; p = 0.025), as well as the mean (r = -0.332; p = 0.005) and maximum (r = -0.334; p = 0.005) abduction force. CONCLUSIONS Shoulder function and pain in subacromial impingement are best predicted by the width of the subdeltoid bursa measured in the coronal MRI plane as an indicator of bursitis as well as the presence of a "halo-sign" around the biceps tendon indicating glenohumeral joint effusion. Presence of a subacromial spur could lead to subacromial and subdeltoid bursitis, which impairs shoulder function. Shoulder function seems not to be compromised by the presence of a subacromial spur in absence of bursitis. This study was registered at the German Clinical Trials Register on 08 February 2013 (ID: DRKS00011548).
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Affiliation(s)
- Malte Jäschke
- grid.413108.f0000 0000 9737 0454Department of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
| | - Hans-Christian Köhler
- Department of Trauma Surgery and Orthopaedics, German Armed Forces Hospital of Westerstede, Lange Str. 38, 26655 Westerstede, Germany
| | - Marc-André Weber
- grid.413108.f0000 0000 9737 0454Department of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
| | - Thomas Tischer
- grid.413108.f0000 0000 9737 0454Department of Orthopaedics, Rostock University Medical Center, Doberaner Str. 142, 18057 Rostock, Germany
| | - Claudia Hacke
- grid.412468.d0000 0004 0646 2097Department of Pediatrics I, University Medical Center Schleswig-Holstein, Arnold-Heller- Straße 3, 24105 Kiel, Germany
| | - Christoph Schulze
- grid.413108.f0000 0000 9737 0454Department of Orthopaedics, Rostock University Medical Center, Doberaner Str. 142, 18057 Rostock, Germany ,Department of Trauma Surgery and Orthopaedics, German Armed Forces Hospital of Westerstede, Lange Str. 38, 26655 Westerstede, Germany
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15
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Wang DM, Li C, Hatchard N, Chang Chien GC, Alm J. Lower trapezius muscle function in people with and without shoulder and neck pain: a systematic review. J Osteopath Med 2023; 123:73-89. [PMID: 36100364 DOI: 10.1515/jom-2022-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/04/2022] [Indexed: 01/27/2023]
Abstract
CONTEXT Shoulder and neck pain are leading causes of disability worldwide. Rotator cuff pathology has strong associations with such pain and is extensively targeted by healthcare practitioners. A dysfunctional lower trapezius muscle has also been shown to contribute to neck and shoulder pain, yet it is often overlooked. OBJECTIVES This systematic review analyzes those with a history of, or who are currently managing, shoulder or neck pain to indicate differences in measures of lower trapezius function when compared to subjects without that pain. METHODS Studies with no age restrictions were included in the study. Studies could determine lower trapezius muscle function with any quantifiable measurement tool or clinical assessment. If the study included a control group (no pain) and a comparator group (pain), and if lower trapezius muscle function was assessed in both, the study was typically included. The significance of the lower trapezius muscle function change was summarized in these pain patients. From a final total of 18 studies identified, level of muscle activity, muscle activation, time to onset, muscle strength, and muscle thickness were reported. RESULTS The 18 included articles involved 485 participants with shoulder and/or neck pain and 455 without. Half of the shoulder pain studies (6/12), and all of the neck pain studies (6/6), demonstrated that the lower trapezius had a noticeable impact. The lower trapezius muscle in participants with shoulder and neck pain tended to show decreased muscle strength, and decreased time to onset/latency. CONCLUSIONS The findings from this systematic review should be taken into consideration when assessing and treating patients with shoulder and neck pain. Future studies that define the type and duration of shoulder and neck pain, as well as prospectively assessing lower trapezius muscle function in those with and without that pain, are needed.
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Affiliation(s)
- Daniel M Wang
- Kansas City University, 1750 Independence Avenue, Kansas City, MO 64106-1453, USA
| | - Crystal Li
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nicole Hatchard
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - George C Chang Chien
- Pain Management, Ventura County Medical Center, Ventura, CA, USA.,Center for Regenerative Medicine, Southern California University of Health Sciences, Whittier, CA, USA
| | - John Alm
- Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
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Effectiveness of Ultrasound-Guided Versus Anatomic Landmark-Guided Corticosteroid Injection on Pain, Physical Function, and Safety in Patients With Subacromial Impingement Syndrome: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil 2022; 101:1087-1098. [PMID: 34966059 PMCID: PMC9668382 DOI: 10.1097/phm.0000000000001940] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of the study was to compare the efficacy and safety of ultrasound-guided versus anatomic landmark-guided corticosteroid injection for the treatment of subacromial impingement syndrome. DESIGN PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, Scopus, ClinicalTrials.gov , CBM, CNKI, and Wanfang databases were searched from inception to August 15, 2021, for randomized controlled trials comparing ultrasound-guided versus anatomic landmark-guided injections of corticosteroids for the treatment of subacromial impingement syndrome. RESULTS Twelve randomized controlled trials with 891 patients were included in this study; 454 patients received ultrasound-guided injections and 437 received anatomic landmark-guided injections. Pooled results showed that ultrasound-guided injection was more beneficial for pain relief (10 trials; mean difference = -0.58; 95% confidence interval = -1.05 to -0.10; P = 0.017) and functional improvement (11 trials; standard mean difference = -0.84; 95% confidence interval = -1.41 to -0.27; P = 0.004). There was no significant difference in shoulder range of motion. In the subgroup analysis, there was a significant difference in pain relief and functional improvement at 6-8 wks and with methylprednisolone. CONCLUSIONS Ultrasound-guided injection of corticosteroids is potentially superior to anatomic landmark-guided injection in improving the clinical symptoms of subacromial impingement syndrome; however, these findings should be interpreted with some caution as the quality of evidence was rated as moderate to very low.
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Vogel M, Binneböse M, Wallis H, Lohmann CH, Junne F, Berth A, Riediger C. The Unhappy Shoulder: A Conceptual Review of the Psychosomatics of Shoulder Pain. J Clin Med 2022; 11:jcm11185490. [PMID: 36143137 PMCID: PMC9504378 DOI: 10.3390/jcm11185490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Chronic pain is a multifaceted disorder genuinely entangled with psychic and psychosomatic symptoms, which are typically involved in the processes of chronification. The impingement syndrome of the shoulder is no exception to this rule, but several studies have shown respective peculiarities among those with pain and impingement of the shoulder. Notably, chronic pain is a lateralized experience, and, similarly, its psychosomatic correlates may be attached to the hemispheres functionally. AIM The present review therefore gives an overview of the respective findings, with regard not only to psychopathology, but also to personality factors and psychologic trauma, since the latter are reportedly associated with chronic pain. Moreover, we acknowledge symmetry as a possible pathogenic factor. METHODS This narrative review followed the current standards for conducting narrative studies. Based on prior findings, our research strategy included the relevance of psychotraumatologic and symmetrical aspects, as well as comorbidity. We retrieved the relevant literature reporting on the impact of psychopathology as well as personality features on shoulder pain, as published up to January 2022 from the Medline database (1966-2022). Study selecton: We included numerous studies, and considered the contextual relevance of studies referring to the neuropsychosomatics of chronic pain. RESULTS Pain-specific fears, depression, and anxiety are important predictors of shoulder pain, and the latter is generally overrepresented in those with trauma and PTSD. Moreover, associations of shoulder pain with psychological variables are stronger as regards surgical therapies as compared to conservative ones. This may point to a specific and possibly trauma-related vulnerability for perioperative maladaptation. Additionally, functional hemispheric lateralization may explain some of those results given that limb pain is a naturally lateralized experience. Not least, psychosocial risk factors are shared between shoulder pain and its physical comorbidities (e.g., hypertension), and the incapacitated state of the shoulder is a massive threat to the function of the human body as a whole. CONCLUSIONS This review suggests the involvement of psychosomatic and psychotraumatologic factors in shoulder impingement-related chronic pain, but the inconclusiveness and heterogeneity of the literature in the field is possibly suggestive of other determinants such as laterality.
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Affiliation(s)
- Matthias Vogel
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von Guericke-University of Magdeburg, 39120 Magdeburg, Germany
- Correspondence: ; Tel.: +49391-6714200; Fax: +49391-6714202
| | - Marius Binneböse
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von Guericke-University of Magdeburg, 39120 Magdeburg, Germany
| | - Hannah Wallis
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von Guericke-University of Magdeburg, 39120 Magdeburg, Germany
| | - Christoph H. Lohmann
- Department of Orthopedic Surgery, Otto-von Guericke-University of Magdeburg, 39120 Magdeburg, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von Guericke-University of Magdeburg, 39120 Magdeburg, Germany
| | - Alexander Berth
- Department of Orthopedic Surgery, Otto-von Guericke-University of Magdeburg, 39120 Magdeburg, Germany
| | - Christian Riediger
- Department of Orthopedic Surgery, Otto-von Guericke-University of Magdeburg, 39120 Magdeburg, Germany
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Effects of a Novel Proprioceptive Rehabilitation Device on Shoulder Joint Position Sense, Pain and Function. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091248. [PMID: 36143925 PMCID: PMC9505091 DOI: 10.3390/medicina58091248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Shoulder disorders are associated with pain, restricted range of motion and muscular strength, moderate disability and diminished proprioception. This study aimed to compare the effectiveness of an innovative technology-supported and a classical therapist-based proprioceptive training program in addition to conventional physiotherapy, on joint position sense (JPS), pain and function, in individuals with different musculoskeletal shoulder disorders, such as rotator cuff tear, subacromial impingement syndrome and superior labrum anterior and posterior tear. The innovative element of the proprioceptive training programme consists of the use of the Kinesimeter, a device created for both training and assessing shoulder JPS. Materials and Methods: The shoulder JPS test and the DASH outcome questionnaire were applied to fifty-five individuals (28 females, 27 males, mean age 56.31 ± 6.75), divided into three groups: 17 in the conventional physiotherapy group (control group); 19 in the conventional physiotherapy + classical proprioceptive training program group (CPT group); and 19 in the conventional physiotherapy + innovative proprioceptive training program group (KPT group). Assessments were performed before and after a four-week rehabilitation program, with five physiotherapy sessions per week. Results: When baseline and post-intervention results were compared, the value of the shoulder JPS and DASH outcome questionnaire improved significantly for the KPT and CPT groups (all p < 0.001). Both KPT and CPT groups showed statistically significant improvements in JPS, pain and function, compared to the control group which received no proprioceptive training (all p < 0.05). However, the KPT group showed no significant benefits compared to the CPT group. Conclusions: Our findings indicate that using the Kinesimeter device as a novel, innovative proprioceptive training tool has similar effects as the classical proprioceptive training programs among individuals with different non-operated musculoskeletal shoulder disorders such as: rotator cuff tear, subacromial impingement syndrome, and superior labrum anterior and posterior tear.
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Singh H, Thind A, Mohamed NS. Subacromial Impingement Syndrome: A Systematic Review of Existing Treatment Modalities to Newer Proprioceptive-Based Strategies. Cureus 2022; 14:e28405. [PMID: 36171841 PMCID: PMC9509002 DOI: 10.7759/cureus.28405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 11/06/2022] Open
Abstract
Musculoskeletal pain is a common reason for primary care visits, with many visits for shoulder pain due to subacromial impingement syndrome (SIS). Current treatments lack evidence for effective management, showing only temporary outcomes. This systematic review evaluates existing modalities in comparison to the use of more permanent proprioceptive-based strategies. Specifically, this meta-analysis compared the use of kinesiology tape, myofascial trigger point release (MPTR), scapular stabilization exercises (SSE), and resistance training. PubMed, BioMedCentral, and ScienceDirect databases were queried for studies evaluating proprioceptive-based exercises in the last nine years. In total, 48 studies met the inclusion and exclusion criteria. After removing duplicates, a total of 14 level 1 studies were left. Kinesiology tape use demonstrated a statistically significant reduction in pain-free range of motion. MPTR improved in all pain scores and the disability scores index. SSE also reduced pain; however, mixed results were seen for range of motion. Finally, resistance training not only reduced pain but improved proprioception and joint position sense. Even though all techniques showed some promise in treating SIS, further large-scale studies exploring related outcomes are needed.
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Bhan K, Singh B. Efficacy of Platelet-Rich Plasma Injection in the Management of Rotator Cuff Tendinopathy: A Review of the Current Literature. Cureus 2022; 14:e26103. [PMID: 35875287 PMCID: PMC9297117 DOI: 10.7759/cureus.26103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2022] [Indexed: 11/24/2022] Open
Abstract
Platelet-rich plasma (PRP) is being projected as a newer and superior treatment option for rotator cuff tendinopathy. With the first use of PRP in trauma and orthopedics dating back only to 1998, its advent into the field is relatively recent. Thus, data on long-term efficacy, large cohort studies, or large randomized controlled trials are fairly limited. Moreover, owing to the absence of standardized methods of platelet extraction and lack of consensus on the ideal concentration of platelets in PRP, data comparison from different studies is difficult. Things are complicated by the fact that it is also not clear whether a single injection of PRP is therapeutic or if multiple serial injections are needed to produce the desired effects. The literature on efficacy and pain relief is also obtained from studies with low sample sizes and short follow-ups. The dropout rate and noncompliance rate were also found to be high in some studies. Thus, the data is often not clinically significant and may also be biased due to the non-standardized inclusion and exclusion criteria of the studies. Though multiple studies have suggested good pain control with PRP injection, many studies have found that PRP injection therapy may not be any better than the physical therapy regimen prescribed to patients with rotator cuff tendinopathy. Also, the data on the efficacy of PRP on shoulder function and shoulder range of motion is at variance. This submission aims to evaluate the efficacy and use of PRP in the management of rotator cuff tendinopathy.
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Bacha R, Gilani SA, Hanif A, Manzoor I. Interobserver agreement on the sonographic severity grading of shoulder impingement syndrome. Ultrasound J 2022; 14:22. [PMID: 35648297 PMCID: PMC9160167 DOI: 10.1186/s13089-022-00272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 05/01/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Shoulder impingement syndrome is the painful entrapment of the soft tissues between the acromion and the humeral head. The severity of shoulder impingement could be graded according to the limitation of shoulder joint moment. The reliability of sonographic findings in the grading of shoulder impingement severity grading is required to be evaluated by the consistency of findings between the observers. PURPOSE To assess the interobserver agreement in the sonographic severity grading of shoulder impingement syndrome with the help of a ratio between acromion-to-greater tuberosity distance in the abduction and neutral arm position. MATERIAL AND METHODS Patients were examined by two independent observers in the coronal approach with neutral arm position. Acromion-to-greater tuberosity distance was measured in abduction and neutral shoulder position. The ratios of the distances in the abduction and neutral position were calculated to grade the severity of shoulder impingement syndrome. RESULTS A total of 78 shoulders were included in this study. A strong agreement was found for the grading of shoulder impingement severity grading between the two independent observers with Kappa value of 0.94. And correlation between the results of the two observers for the severity grading of shoulder impingement syndrome was significant at 0.01 level. CONCLUSION Severity grading of the shoulder impingement syndrome was performed based on the ratio of acromion-to-greater tuberosity distance in abduction and neutral arm position. However, the sonographic findings were consistent and a strong interobserver agreement was seen in this sonographic severity grading.
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Affiliation(s)
- Raham Bacha
- The University of Lahore, Lahore, Pakistan.
- Gilani Ultrasound Center Affroasian Institute Lahore, Lahore, Pakistan.
| | - Syed Amir Gilani
- The University of Lahore, Lahore, Pakistan
- Gilani Ultrasound Center Affroasian Institute Lahore, Lahore, Pakistan
| | - Asif Hanif
- The University of Lahore, Lahore, Pakistan
- Gilani Ultrasound Center Affroasian Institute Lahore, Lahore, Pakistan
| | - Iqra Manzoor
- The University of Lahore, Lahore, Pakistan
- Gilani Ultrasound Center Affroasian Institute Lahore, Lahore, Pakistan
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22
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Gremen E, Frandon J, Lateur G, Finas M, Rodière M, Horteur C, Benassayag M, Thony F, Pailhe R, Ghelfi J. Safety and Efficacy of Embolization with Microspheres in Chronic Refractory Inflammatory Shoulder Pain: A Pilot Monocentric Study on 15 Patients. Biomedicines 2022; 10:biomedicines10040744. [PMID: 35453492 PMCID: PMC9028229 DOI: 10.3390/biomedicines10040744] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose: Musculoskeletal (MSK) embolization is emerging in tendinopathy treatment. The objective of this study was to assess the efficacy and safety of MSK embolization with microspheres in the treatment of chronic shoulder pain. Patients and methods: This retrospective monocentric study included patients with chronic shoulder pain resistant to 6 months or more of conventional therapies who were treated with MSK embolization between 2017 and 2021. Embolization was performed using calibrated 100–250 µm microspheres. Clinical success was defined as pain reduction, i.e., a decrease in the visual analogue scale (VAS) pain score of ≥50% at 3 months after MSK embolization as compared to baseline. Adverse events were collected. Results: Fifteen patients (11 women, 4 men) were included, with a median age of 50.3 years (IQR: 46.7–54.5). The median duration of symptoms was 26.6 months (20.6–39.8). The median VAS pain scores were 7.0 (7.0–8.0) at baseline, 6.0 (3.5–7.0) at 1 month, 5.0 (4.5–6.5) and 5.0 (3.0–7.4) at 3 months and 6 months (p = 0.002). Three patients (20%) reported clinical success at 3 months. Three patients experienced minor complications after embolization (paresthesia, n = 2; transient osteo-medullary edema, n = 1) and two patients had moderate complications (transient skin ischemia). Conclusion: MSK embolization with microspheres for treatment of refractory chronic shoulder pain showed moderate results in terms of clinical success and safety.
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Affiliation(s)
- Emeric Gremen
- Faculty of Medecine, Grenoble-Alpes University, 38043 Grenoble, France; (E.G.); (R.P.)
- Radiology Department, Grenoble Alpes University Hospital, 38043 Grenoble, France; (M.F.); (M.R.); (F.T.)
| | - Julien Frandon
- Radiology Department, Nimes University Hospital, University of Montpellier, 30900 Nimes, France;
| | - Gabriel Lateur
- Orthopaedic and Traumatology Surgery Department, Albertville Hospital, 73200 Albertville, France;
| | - Mathieu Finas
- Radiology Department, Grenoble Alpes University Hospital, 38043 Grenoble, France; (M.F.); (M.R.); (F.T.)
| | - Mathieu Rodière
- Radiology Department, Grenoble Alpes University Hospital, 38043 Grenoble, France; (M.F.); (M.R.); (F.T.)
| | - Clément Horteur
- Department of Orthopaedic Surgery, Grenoble Alpes University Hospital, 38043 Grenoble, France;
| | - Michaël Benassayag
- Orthopaedic Surgery Department, Medipôle de Savoie Hospital, 73190 Challes-les-Eaux, France;
| | - Frédéric Thony
- Radiology Department, Grenoble Alpes University Hospital, 38043 Grenoble, France; (M.F.); (M.R.); (F.T.)
| | - Régis Pailhe
- Faculty of Medecine, Grenoble-Alpes University, 38043 Grenoble, France; (E.G.); (R.P.)
- Department of Orthopaedic Surgery, Grenoble Alpes University Hospital, 38043 Grenoble, France;
| | - Julien Ghelfi
- Faculty of Medecine, Grenoble-Alpes University, 38043 Grenoble, France; (E.G.); (R.P.)
- Radiology Department, Grenoble Alpes University Hospital, 38043 Grenoble, France; (M.F.); (M.R.); (F.T.)
- Institute of Advanced Biosciences, INSERM U1209, CNRS UMR 5309, 38043 Grenoble, France
- Correspondence: ; Tel.: +33-4-76-76-89-09
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23
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Ge M, Zhang Y, Li Y, Feng C, Tian J, Huang Y, Zhao T. Publication Trends and Hot Spots in Subacromial Impingement Syndrome Research: A Bibliometric Analysis of the Web of Science Core Collection. J Pain Res 2022; 15:837-856. [PMID: 35370418 PMCID: PMC8974249 DOI: 10.2147/jpr.s348528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background In recent years, the research on subacromial impingement syndrome (SIS) has gradually increased. Although the research directions are diverse, the overall research status and trend are not clear. Objective The aim of our study was to use bibliometric analysis to identify the trends in SIS-related research and to analyze the most highly cited scientific publications on SIS. Methods All data were retrieved from the Web of Science Core Collection database, and the year of publications, countries, journals, institutions and total number of citations were extracted and analyzed. The results related to countries, institutions and keywords were then analyzed using VOSviewer software and bibliometrics online analysis platform. And, we also identified the 100 most cited articles on SIS. Results A total of 548 articles related to AIS were identified. The frequency of publication on SIS has increased substantially over time. Among all countries, Turkey has contributed the most publications on SIS (n=118). The institution with the most articles was Istanbul University (n=17). Journal of Shoulder and Elbow Surgery topped the list of journals and has published 19 SIS-related publications. The hotspot of research changed from the former arthroscopic surgery to physical therapy and rehabilitation. Conclusion The scientific research on SIS has rapidly expanded in recent years. This study represents the first bibliometric analysis of SIS, gives us a systematic and comprehensive summary into the development of SIS.
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Affiliation(s)
- Meng Ge
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People's Republic of China
- Bengbu Medical College, Bengbu, People's Republic of China
| | - Yuan Zhang
- Bengbu Medical College, Bengbu, People's Republic of China
- Center for General Practice Medicine, Department of Rheumatology and Immunology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Yanlei Li
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People's Republic of China
- Bengbu Medical College, Bengbu, People's Republic of China
| | - Chenchen Feng
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People's Republic of China
- Bengbu Medical College, Bengbu, People's Republic of China
| | - Jinlong Tian
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People's Republic of China
- Bengbu Medical College, Bengbu, People's Republic of China
| | - Yazeng Huang
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People's Republic of China
- Bengbu Medical College, Bengbu, People's Republic of China
| | - Tingxiao Zhao
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People's Republic of China
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Kannappan SP, Bagoji I, Kumar S. A morphometric study of spinoglenoid notch, subcoracoacromial arch, and spinous process of the scapula on shoulder impingement. MGM JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4103/mgmj.mgmj_183_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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25
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Nizam Siron K, Mat Lani MT, Low CL, Kow RY. Arthroscopic Subacromial Decompression in the Treatment of Shoulder Impingement Syndrome: A Prospective Study in Malaysia. Cureus 2021; 13:e19254. [PMID: 34900455 PMCID: PMC8648140 DOI: 10.7759/cureus.19254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/07/2022] Open
Abstract
Introduction Shoulder impingement syndrome (SIS) is one of the common problems which lead to shoulder disabilities. This condition has been described as impingement to the rotator cuff by the anterior third of the acromion process and has been classified into three stages. Treatment option varies depending on the grade of the disease. Arthroscopic subacromial decompression (ASAD) has become more popular in recent years and has shown to have a good outcome. The purpose of this study is to evaluate the outcomes following ASAD in terms of the functional, clinical, and radiological parameters in treating SIS in the ageing population in Kuantan, Pahang, Malaysia. Materials and methods This was an observational study looking at the outcomes of patients with stage 2 and stage 3 (partial cuff tear) impingement syndrome who underwent ASAD in Hospital Tengku Ampuan Afzan and International Islamic University Malaysia Medical Centre from May 2018 to June 2019. The functional outcomes were evaluated using American Shoulder and Elbow Surgeons (ASES) score taken at pre-operative, six weeks, three months, and six months post-operation. Clinical outcomes were evaluated using Constant score (CS) taken at six months post-operation. Radiological outcomes were measured by comparing acromiohumeral distance pre- and post-operation on anteroposterior (AP) view radiograph of the affected shoulder. Results A total of 28 patients were selected for the study. On functional outcome, there was a significant effect of time on the ASES scoring system (p-value <0.05) from pre-operative to six months post-operation. On clinical outcome, the CS at six months showed 13 patients have excellent scores, 10 have good, and five have fair scores. There was a statistically significant difference in mean values of all categories (p-value <0.05). In terms of the radiological outcome, this study observed a significant increase in patients’ subacromial space on X-ray from the pre-operative and post-operative treatment stages. In this study, we also observed that there was no significant difference in outcomes between partial and intact rotator cuff (RC) tears at six-month post-operation. Conclusion In this study, ASAD was found to be a beneficial intervention in the treatment of patients with shoulder impingement evidenced by the significant outcomes in terms of functional, clinical, and radiological parameters.
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Affiliation(s)
- Khairul Nizam Siron
- Department of Orthopaedics, Traumatology & Rehabilitation, International Islamic University Malaysia, Kuantan, MYS
| | - Muhamad Taufik Mat Lani
- Department of Orthopaedics, Traumatology & Rehabilitation, International Islamic University Malaysia, Kuantan, MYS
| | - Chooi Leng Low
- Department of Radiology, International Islamic University Malaysia, Kuantan, MYS
| | - Ren Yi Kow
- Department of Orthopaedics, Traumatology & Rehabilitation, International Islamic University Malaysia, Kuantan, MYS
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Pérez-de la Cruz S. Use of a Portable Inertial Measurement Unit as an Evaluation Method for Supraspinatus Muscle: Proposed Normative Values. SENSORS 2021; 21:s21227723. [PMID: 34833798 PMCID: PMC8625058 DOI: 10.3390/s21227723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/10/2021] [Accepted: 11/14/2021] [Indexed: 11/21/2022]
Abstract
Treatment protocols do not specify an appropriate weight for rehabilitating the shoulder joint. The purpose of this study was to establish normative values for the shoulder abduction range of motion and recommended weights to be used in the rehabilitation process after injury to the supraspinatus muscle. Fifty-eight volunteers were assessed using the DyCare system. A test was conducted by lifting the arm to a 90° angle and having the participants lift different weights. The range of motion was similar for both sexes, suggesting that sex had no influence on this variable. Regarding the use of weights, men did not show as much stability in their movement execution, with a high dispersion seen in values between zero and three kilograms of weight, reaching a maximum weight of six kilograms. However, women showed good joint stability from the beginning of the test, with values that remained constant as weight increased up to a maximum of five kilograms. In conclusion, no major differences were observed in supraspinatus muscle injury recovery according to sex. However, differences were observed in the amount of weight that was necessary and appropriate to allow the participants to recover their muscular strength and avoid relapses.
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Affiliation(s)
- Sagrario Pérez-de la Cruz
- Department of Nursing, Physical Therapy and Medicine, University of Almería, La Cañada de San Urbano, 04120 Almería, Spain
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27
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Erian C, Erian M, Raniga S. Impingement on the internet: evaluating the quality and readability of online subacromial impingement information. BMJ Open Sport Exerc Med 2021; 7:e001203. [PMID: 34795906 PMCID: PMC8572409 DOI: 10.1136/bmjsem-2021-001203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/06/2022] Open
Abstract
Patients increasingly access the internet to learn about their orthopaedic conditions. Despite this, online information may be unregulated, of questionable quality and difficulty to read. OBJECTIVES Therefore, this study aimed to evaluate the readability and quality of the online information concerning subacromial impingement syndrome. METHODS A search using Australia's three most popular online search engines was undertaken using the search terms 'subacromial impingement syndrome' and 'shoulder impingement'. The first 15 websites for each term were evaluated. Duplicates, advertisements and sponsored links were removed.The quality and readability of each website were calculated using the DISCERN and Flesch-Kincaid Reading Ease (FKRE) tools, respectively. The differences in quality and readability between each website type (healthcare/academic, commercial, news outlet, charitable/not-for-profit, layperson, government) was assessed using analysis of variance. The correlation between quality and readability was assessed using the Pearson correlation coefficient. RESULTS The majority of 35 unique websites analysed were of 'poor'/'fair' quality (determined via the DISCERN instrument) and 'difficult' readability (per the FKRE tool), with no correlation established between the scores. There was no statistically significant difference in quality across website types, however layperson, news outlet and government websites were found to be significantly more readable than alternate website categories (p<0.05). CONCLUSIONS We determined that much of the online information concerning subacromial impingement syndrome may be difficult to read and/or of poor quality. By recognising the shortcomings of information accessed by patients online, it is hoped clinicians may be prompted to better educate their patients.
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Affiliation(s)
- Christopher Erian
- Griffith University School of Medicine, Gold Coast, Queensland, Australia
| | - Michael Erian
- The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - Sumit Raniga
- Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
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Xin Ooi MW, Fenning L, Dhir V, Basu S. Rotator cuff assessment on imaging. J Clin Orthop Trauma 2021; 18:121-135. [PMID: 33996457 PMCID: PMC8102769 DOI: 10.1016/j.jcot.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/28/2021] [Accepted: 04/03/2021] [Indexed: 11/29/2022] Open
Abstract
The rotator cuff is a group of four muscles and tendons surrounding the shoulder joint providing it strength and stability. The rotator cuff consists of the subscapularis, supraspinatus, infraspinatus and teres minor. Many shoulder complaints are caused by rotator cuff pathology such as impingement syndrome, tendon tears and other diseases e.g. calcific tendonitis. Diagnosis starts with clinical history and physical examination, after which imaging is often used to help confirm clinical findings depending on the differential diagnosis. The aim of the article is to review the frequently used imaging modalities to assess the rotator cuff and cuff-related disease, specifically focusing on radiography, ultrasonography and magnetic resonance imaging. This article will outline the advantages and disadvantages for each modality and illustrate typical radiological findings of common rotator cuff pathologies.
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Affiliation(s)
| | | | | | - Subhasis Basu
- Corresponding author. Radiology Department, Wrightington, Wigan and Leigh NHS Trust, Hall Ln, Appley Bridge, Wigan, WN6 9EP, United Kingdom.
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29
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Brindisino F, Mourad F, Maselli F. Elastofibroma presented as shoulder pain in an amateur swimmer: screening for referral in physiotherapy. A case report. Physiother Theory Pract 2021; 38:2257-2267. [PMID: 33910473 DOI: 10.1080/09593985.2021.1920077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Elastofibroma is a benign and rare fibroblast/myofibroblast tumor usually located near the periosteum of the ribs. Patients with elastofibroma can remain asymptomatic or can experience a clicking sensation during shoulder movements, shoulder stiffness, scapular and shoulder pain and dysfunction. Importantly, the symptoms can mimic a musculoskeletal condition being mistaken for orthopedic shoulder joint disease. A 54 years-old amateur swimmer self-referred to physiotherapy for left subscapular and shoulder pain. Concerns from the patient's history that caused suspicion of a medical condition included an insidious onset of nagging deep pain that increased with upper limb exertion and an audible thoracic clunk at arm end range flexion. Deep palpatory examination revealed a mass below the latissimus dorsi and rhomboids further screened by the physiotherapist with Rehabilitative Ultrasound Imaging. The physiotherapist referred the patient to a thoracic surgeon who removed the mass. After an exercise-based physiotherapy management program, the patient returned to previous activities including swimming after 5 months. The challenge for clinicians is to screen patients in whom shoulder pain may be related to non-musculoskeletal conditions. Prompt referral of patients presenting with the suspicion of elastofibroma to an appropriate physician may lead to a timely diagnosis and could avoid expensive and unnecessary rehabilitation procedures.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.,Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Roma "Tor Vergata", Roma, Italy
| | - Firas Mourad
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Roma "Tor Vergata", Roma, Italy.,Department of Physical Therapy, Poliambulatorio Physio Power, Brescia, Italy
| | - Filippo Maselli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova-Campus of Savona, Savona, Italy
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Bolia IK, Collon K, Bogdanov J, Lan R, Petrigliano FA. Management Options for Shoulder Impingement Syndrome in Athletes: Insights and Future Directions. Open Access J Sports Med 2021; 12:43-53. [PMID: 33880071 PMCID: PMC8053512 DOI: 10.2147/oajsm.s281100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/13/2021] [Indexed: 01/02/2023] Open
Abstract
Athletes participating in overhead sports are at particularly high risk of shoulder impingement syndrome. Subcoracoid impingement is defined as impingement of the anterior soft tissues of the shoulder between the coracoid process and the lesser tuberosity. Subacromial impingement syndrome (SIS) occurs due to extrinsic compression of the rotator cuff between the humeral head and coracoacromial structures or intrinsic degeneration of the supraspinatus tendon and subsequent superior migration of the humerus. Internal impingement is a major cause of shoulder pain in overhead athletes, and it occurs due to repetitive impingement of the articular surface of the rotator cuff with the glenoid during maximum abduction and external rotation of the arm. When examining athletes with suspected impingement of the shoulder, it is important to discuss the sport-specific motion that regenerates the symptoms and perform a combination of physical examination tests to improve the diagnostic accuracy. Radiographic evaluation is recommended, and the extent of soft tissue abnormalities can be assessed on ultrasound or magnetic resonance imaging of the shoulder. Management of shoulder impingement syndrome can be conservative or operative, based on the severity and chronicity of symptoms and the associated structural abnormalities. This review provides an update on the management of SIS, subcoracoid impingement, and internal impingement in the athletic population.
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Affiliation(s)
- Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Kevin Collon
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Jacob Bogdanov
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Rae Lan
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Frank A Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
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Jildeh TR, Ference DA, Abbas MJ, Jiang EX, Okoroha KR. Scapulothoracic Dyskinesis: A Concept Review. Curr Rev Musculoskelet Med 2021; 14:246-254. [PMID: 33822304 DOI: 10.1007/s12178-021-09705-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Scapulothoracic dyskinesis (SD) occurs when there is a noticeable disruption in typical position and motion of the scapula, which can result in debilitating pain. The purpose of this review is to describe the current knowledge regarding the diagnosis and management of scapulothoracic dyskinesis by providing an evidence-based overview of clinical exams and treatment modalities available for orthopedic surgeons and provide insight into which treatment modalities require further investigation. RECENT FINDINGS SD is highly prevalent in athletes, particularly those participating in overhead activities (e.g., baseball, tennis, and swimming) and can coexist with several shoulder pathologies. A holistic approach in the diagnosis of SD has been supported in the literature; however, it is important to recognize that diagnosis is currently limited to the absence of a quantitative SD clinical assessment. The main goal of the treatment of SD is to regain proper scapular positioning and dynamics. The standard of care for the management of SD is conservative interventions aimed at optimizing scapular kinematics. Surgical intervention is only considered in the presence of concomitant pathology requiring surgery. Due to the complexity of coordinated movement of the shoulder girdle, recent literature has begun to move away from the use of traditional orthopedic tests, in favor of a more system-based approach for the diagnosis of SD. We present a concise review of clinical exams and treatment modalities available for orthopedic surgeons in the management of SD.
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Affiliation(s)
- Toufic R Jildeh
- Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA.
| | - Daisy A Ference
- Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
| | - Muhammad J Abbas
- Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - Eric X Jiang
- Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - Kelechi R Okoroha
- Mayo Clinic, Department of Orthopedic Surgery, 600 Hennepin Avenue, Suite 310, Minneapolis, MN, 55403, USA
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Rodríguez-Sanz J, López-de-Celis C, Hidalgo-García C, Canet-Vintró M, Fanlo-Mazas P, Pérez-Bellmunt A. Temperature and current flow effects of different electrode placement in shoulder capacitive-resistive electric transfer applications: a cadaveric study. BMC Musculoskelet Disord 2021; 22:139. [PMID: 33541324 PMCID: PMC7860630 DOI: 10.1186/s12891-020-03918-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Impingement syndrome is currently estimated to represent 60% of all shoulder pain disorders. Capacitive-Resistive electric transfer therapy is aimed to provoke temperature and current flow changes in superficial and deep tissues. This in vitro study has evaluated the variation of temperature and current flow in the shoulder tissues during two different areas of application of the movable capacitive-resistive electric transfer electrode. METHODS A cross-sectional study designed, five fresh cryopreserved cadavers (10 shoulders) were included in this study. Four interventions (capacitive and resistive modes; low- and high-power) were performed for 5 min each by a diathermy "T-Plus" device in two shoulder regions: postero-superior and antero-lateral. Supraspinatus tendon, glenohumeral capsule and superficial temperatures were recorded at 1-min intervals and 5 min after treatment. RESULTS A statistically significant difference was found only for the superficial area and time interaction, with high power-resistive application at the postero-superior shoulder area (P< 0.035). All the applications showed a 5 min after treatment temperature increase compared with the basal data, in all the application points. Superficial temperature in the high power-resistive application showed the greatest percent increase (42.93% ± 22.58), followed by the temperature in the tendon area with the same high power-resistive application (22.97% ± 14.70). The high power-resistive application showed the greatest percent of temperature increase in the applications, reaching 65.9% ± 22.96 at 5-min at the superficial level, and 32% ± 24.25 at 4-min at the level of the supraspinatus tendon. At the capsule level, high power-resistive was also the application that showed the greatest percent of increase, with 21.52% ± 16.16. The application with the lowest percent of temperature increase was the low power-capacitive, with a mean value of 4.86% at supraspinatus tendon level and 7.47% at capsular level. CONCLUSION The shoulder postero-superior or antero-lateral areas of application of capacitive-resistive electric transfer did not cause statistically significant differences in the temperature changes in either supraspinatus tendon or glenohumeral capsule tissues in cadaveric samples. The high power-resistive application in the postero-superior area significantly increased superficial temperature compared with the same application in the antero-lateral position area.
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Affiliation(s)
- Jacobo Rodríguez-Sanz
- Universitat Internacional de Catalunya. Actium functional anatomy group. Faculty of Medicine and Health Sciences, Barcelona, Spain
| | - Carlos López-de-Celis
- Universitat Internacional de Catalunya. Actium functional anatomy group. Faculty of Medicine and Health Sciences, Barcelona, Spain
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - César Hidalgo-García
- Facultad de Ciencias de la Salud de la Universidad de Zaragoza, Unidad de Investigación en Fisioterapia, c/ Domingo Miral s/n, 50009 Zaragoza, Spain
| | - Max Canet-Vintró
- Universitat Internacional de Catalunya. Actium functional anatomy group. Faculty of Medicine and Health Sciences, Barcelona, Spain
| | - Pablo Fanlo-Mazas
- Facultad de Ciencias de la Salud de la Universidad de Zaragoza, Unidad de Investigación en Fisioterapia, c/ Domingo Miral s/n, 50009 Zaragoza, Spain
| | - Albert Pérez-Bellmunt
- Universitat Internacional de Catalunya. Actium functional anatomy group. Faculty of Medicine and Health Sciences, Barcelona, Spain
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Chaimongkhol T, Benjachaya S, Mahakkanukrauh P. Acromial morphology and morphometry associated with subacromial impingement syndrome. Anat Cell Biol 2020; 53:435-443. [PMID: 32963132 PMCID: PMC7769113 DOI: 10.5115/acb.20.166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/02/2020] [Accepted: 08/24/2020] [Indexed: 11/28/2022] Open
Abstract
Acromion is a major associated structure of subacromial impingement syndrome, one of the most common diagnoses in chronic shoulder pain world-wide. The aims of this study are to study morphometry of acromion and to find risk group using acromial morphometry. Total samples were 392 scapulae. The samples were of both sexes, ranging from the age of 31 to 90. Acromion type and osteophytes were observed. Acromial parameters were measured. The relationships were analyzed among acromion type, acromial osteophyte, acromial parameters, age group, sex and side. Curved acromion had the highest prevalence in all age groups. Hooked acromion had the second highest prevalence since the age of 41. Hooked acromion prevalence was higher in male than in female. The highest prevalence of acromial osteophytes was on anteroinferior surface in all age group. The prevalence of acromial osteophytes on anteroinferior surface and acromial facet increased with age. In addition, acromion type was associated with only osteophytes on anteroinferior surface of acromion. Anterior one-third acromial thickness in the age of 31 to 50 was different from those of 51 to 90. There are differences between all parameters and sexes, but not side. General population with age above 50 and concerned male group with age above 40 who have chronic shoulder pain should be investigated for subacromial impingement syndrome. Surgical treatment is recommended because hooked acromion and osteophytes are mostly the root of problem.
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Affiliation(s)
| | - Sirapat Benjachaya
- Department of anatomy Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pasuk Mahakkanukrauh
- Department of anatomy Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Forensic Osteology Research Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Excellence Center in Osteology Research and Training Center (ORTC), Chiang Mai University, Chiang Mai, Thailand
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Gacaferi H, Kolk A, Visser CPJ. Arthroscopic bursectomy less effective in the degenerative shoulder with chronic subacromial pain. JSES Int 2020; 5:220-227. [PMID: 33681841 PMCID: PMC7910744 DOI: 10.1016/j.jseint.2020.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background Varying results after surgery in patients with subacromial pain syndrome (SAPS) have raised the question on whether there is a subgroup of patients that can benefit from surgery. Therefore, we aimed to identify preoperative and peroperative factors associated with a favorable patient-reported outcome after arthroscopic bursectomy in patients with SAPS. Methods Patients with chronic SAPS who underwent arthroscopic bursectomy after failed conservative management were included (n = 94). Patients were evaluated at the baseline, and 2 weeks, 8 weeks, 6 months, and 1 year after surgery. The primary outcome was the Western Ontario Rotator Cuff index (WORC) score one year after surgery. The secondary outcome measure was a visual analog scale for pain. Mixed model analyses were used to identify prognostic factors. Results The mean WORC (mean difference 39%, 95% confidence interval (CI) 32.8-45.3, P < .001) and visual analog scale pain scores (mean difference 41 mm points, 95% CI 3.37-4.88, P < .001) significantly improved one year after surgery. Nineteen patients (20%) developed a postoperative frozen shoulder. A longer duration of preoperative complaints and the peroperative identification of degenerative glenoid cartilage were associated with significantly worse WORC scores, with -0.086% per month (95% CI -0.156 to -0.016, P = .016) and -20% (95% CI -39.4 to -1.26, P = .037), respectively. Conclusion We identified demographic and clinical factors that predict the course after arthroscopic subacromial bursectomy. We found that arthroscopic bursectomy is less effective in patients with SAPS with a degenerative shoulder. This finding suggests that an improved treatment effect of arthroscopic subacromial bursectomy can be expected in patients with chronic SAPS if intra-articular pathologies such as glenohumeral osteoarthritis are sufficiently excluded.
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Affiliation(s)
- Hamez Gacaferi
- Department of Orthopedics, Alrijne Hospital, Leiden, the Netherlands.,Department of Orthopedics, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Arjen Kolk
- Department of Orthopedics, Leiden University Medical Center (LUMC), Leiden, the Netherlands
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Shin HR, Seo J, Park K, Ann SH, Park SJ, Lee S, Yeom SR. Effectiveness and safety of fluoroscopy-guided acupuncture for subacromial impingement syndrome: A randomized, patient-assessor blind, parallel clinical trial. Integr Med Res 2020; 10:100693. [PMID: 33665091 PMCID: PMC7907818 DOI: 10.1016/j.imr.2020.100693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 11/22/2022] Open
Abstract
Background Subacromial impingement syndrome (SIS) is one of the most common causes of shoulder pain, and acupuncture treatment is widely used as treatment. However, no studies have examined image-guided acupuncture for SIS. This study evaluated the effectiveness and safety of low-dose X-ray guided acupuncture (LA) in patients with SIS. Methods A total of 54 patients with SIS were randomly allocated to the LA group and the conventional acupuncture (CA) group. Two acupuncture treatment sessions were conducted for a week, and follow up was conducted after three weeks. The primary outcome was pain intensity measured by the visual analogue scale (VAS) during the Neer and Hawkins test. The incidence rate of shoulder impingement sign, the modified Constant-Murley score (CMS) and the Shoulder Pain and Disability Index (SPADI) were assessed as other outcomes. All indicators were assessed at baseline and after one week and three weeks. For safety evaluation, adverse events were monitored in both groups. Results The change in pain during the Neer test after one week from baseline was more significant in the LA group than in the CA group (p=0.008). However, the Hawkins test did not show a difference between the two groups. The incidence rate of shoulder impingement sign and the changes in CMS and SPADI were not significantly different between the two groups at one week, but after three weeks, SPADI was more significantly improved in the LA group (p=0.024). No adverse events were related to this trial. Conclusion LA was more effective than CA in relieving pain and improving function in terms of VAS and SPADI. Trial registration This study was registered on 23 March 2018 at the Clinical Research Information Service: KCT0002751.
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Affiliation(s)
- Hee-Ra Shin
- Department of Korean Rehabilitation Medicine, Jangheung Integrative Medical Hospital, Wonkwang University, Republic of Korea
| | - Jihye Seo
- College of Korean Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Kyungtae Park
- Department of Korean Rehabilitation Medicine, Gwangju Medical Center, College of Korean Medicine, Wonkwang University, Gwangju, Republic of Korea
| | - Sung-Hu Ann
- Department of Korean Rehabilitation Medicine, Gwangju Medical Center, College of Korean Medicine, Wonkwang University, Gwangju, Republic of Korea
| | - Soo-Ji Park
- Clinical Trial center, Gwangju Medical Center, College of Korean Medicine, Wonkwang University, Gwangju, Republic of Korea
| | - Sangkwan Lee
- Clinical Trial center, Gwangju Medical Center, College of Korean Medicine, Wonkwang University, Gwangju, Republic of Korea
| | - Seung-Ryong Yeom
- Department of Korean Rehabilitation Medicine, Gwangju Medical Center, College of Korean Medicine, Wonkwang University, Gwangju, Republic of Korea
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Brindisino F, Ristori D, Lorusso M, Miele S, Pellicciari L, Rossettini G, Bonetti F, Heick JD, Testa M. Subacromial impingement syndrome: a survey of Italian physiotherapists and orthopaedics on diagnostic strategies and management modalities. Arch Physiother 2020; 10:16. [PMID: 32905154 PMCID: PMC7465722 DOI: 10.1186/s40945-020-00087-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/29/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIM The subacromial impingement syndrome (SIS) represents a common cause of disability in approximately 74% of patients with Shoulder Pain (SP). Even if contemporary research suggests that this mechanism is not (always) the dominant driver in SP, SIS is still a source of debate among scholars and clinicians. From a clinical point of view, evidence has suggested that clinicians can use both medical and physiotherapy approaches as effective methods to treat SIS.This survey aims to investigate models of management of patients with SIS in a sample of Italian physiotherapist specialists (Orthopaedic Manipulative Physical Therapists, -OMPTs-) and orthopaedic surgeons. MATERIALS AND METHODS An online survey with 29-item questionnaire was administered to assess the knowledge of OMPTs and orthopaedic surgeons about: a) strategies of clinical examination; b) the role of imaging in the diagnostic process; c) the physiotherapy management; and d) the pharmacological and surgical management in patients with SIS. RESULTS Six-hundred and twenty-nine respondents completed the survey (511 OMPTs (79.97%) and 128 orthopaedic surgeons (20.03%)). Ninety-two percent (n = 470) of the OMPTs and 80.5% (n = 103) of orthopaedic surgeons stated that in patients with SIS, a combination of diagnostic tests produced better accuracy (p = < 0.001). Twenty point seven % of OMPTs (n = 106) and 4.7% of orthopaedic surgeon (n = 6) stated that the Lift off was the most specific test (p = < 0.001). Four-hundred-and-twenty-four OMPTs (83%) and 40 orthopaedic surgeons (31.3%) answered that the gold standard for diagnosis of a patient with SIS are history and clinical examination (p < 0.001). CONCLUSION OMPTs and orthopaedic surgeons approach patients with SIS differently during both the assessment and the treatment. OMPTs appear to be appropriate in planning and managing clinical examination and therapeutic strategies to use with patients with SIS.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise C/da Tappino c/o Cardarelli Hospital, 86100 Campobasso, Italy
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Diego Ristori
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health – University of Genova – Campus of Savona, Savona, Italy
| | - Mariangela Lorusso
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Simone Miele
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health – University of Genova – Campus of Savona, Savona, Italy
| | | | - Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health – University of Genova – Campus of Savona, Savona, Italy
| | - Francesca Bonetti
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - John Duane Heick
- Department of Physical Therapy and Athletic Training, Northern Arizona University Flagstaff, Flagstaff, AZ USA
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health – University of Genova – Campus of Savona, Savona, Italy
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Genome-Wide Association Analysis Identified ANXA1 Associated with Shoulder Impingement Syndrome in UK Biobank Samples. G3-GENES GENOMES GENETICS 2020; 10:3279-3284. [PMID: 32690583 PMCID: PMC7466970 DOI: 10.1534/g3.120.401257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Shoulder impingement syndrome (SIS) is a common shoulder disorder with unclear genetic mechanism. In this study, Genome-wide Association Study (GWAS) was conducted to identify the candidate loci associated with SIS by using the UK Biobank samples (including 3,626 SIS patients and 3,626 control subjects). Based on the GWAS results, gene set enrichment analysis was further performed to detect the candidate gene ontology and pathways associated with SIS. We identified multiple risk loci associated with SIS, such as rs750968 (P = 4.82 × 10−8), rs754832 (P = 4.83 × 10−8) and rs1873119 (P = 6.39 × 10−8) of ANXA1 gene. Some candidate pathways have been identified related to SIS, including those linked to infection response and hypoxia, “ZHOU_INFLAMMATORY_RESPONSE_FIMA_DN” (P = 0.012) and “MANALO_HYPOXIA_UP” (P = 5.00 × 10−5). Our results provide novel clues for understanding the genetic mechanism of SIS.
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Ultrasound-guided versus blind subacromial corticosteroid and local anesthetic injection in the treatment of subacromial impingement syndrome: A randomized study of efficacy. Jt Dis Relat Surg 2020; 31:115-22. [PMID: 32160504 PMCID: PMC7489127 DOI: 10.5606/ehc.2020.71056] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objectives
This study aims to compare the effects of ultrasound (US)-guided and blind subacromial corticosteroid and local anesthetic (LA) injection in the treatment of subacromial impingement syndrome (SIS) on shoulder pain, range of motion (ROM), and functionality. Patients and methods
The prospective study was conducted between 01 February 2017 and 31 May 2017. A total of 29 patients with clinical findings and magnetic resonance imaging (MRI) consistent with SIS were randomized into two groups: 14 patients received US-guided subacromial corticosteroid and LA injection and 15 patients received a blind subacromial corticosteroid and LA injection. Patients were evaluated before and one month after treatment. One patient was lost to follow up. The primary outcome measure was a visual analog scale (VAS) for shoulder pain. Secondary outcomes were active shoulder ROM in flexion and abduction, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the modified Constant-Murley Score (CMS). Results
Twenty eight patients (11 males, 17 females; mean age 39.5 in the US guided group and 42.5 in the blind group; range 20 to 64 years in both groups) completed the study. There was a significant improvement in VAS for shoulder pain, active ROM, DASH questionnaire score and modified CMS in both groups four weeks after treatment (p<0.05). There was no between-group difference in VAS, ROM or DASH questionnaire scores. Following treatment, the modified CMS in the US-guided injection group was higher than in the blind injection group (p=0.02). However, when the mean change in modified CMS in the US-guided injection group was compared to that of the blind injection group, the difference was insignificant (p=0.23). Conclusion Both US-guided and blind subacromial steroid injection improve shoulder pain, ROM, and functionality in SIS; one treatment option was not found to be superior to the other. Therefore, blind injection can be performed in clinical settings where US is not available. Equally, blind injection can also be performed in patients who have a definite diagnosis of SIS based on clinical and MRI findings.
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Kulakli F, Ilhanli I, Sari IF, Türköz A, Çelik C. Can the efficacy of subacromial corticosteroid injection be improved using a single- session mobilization treatment in subacromial impingement syndrome? A randomized single-blind controlled trial. Turk J Med Sci 2020; 50:205-212. [PMID: 31865665 PMCID: PMC7080397 DOI: 10.3906/sag-1909-51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/22/2019] [Indexed: 12/03/2022] Open
Abstract
Background/aim The objective in this study is to assess the short-term effects of a single-session mobilization in addition to subacromial corticosteroid (SACS) injection in impingement syndrome. Materials and methods The study was designed as a prospective randomized controlled single-blind, parallel group clinical trial. Patients (totally 84) were divided randomly into two groups equally. Forty-two patients in Group 1 received mobilization and SACS injection, whereas 42 patients in Group 2 only received SACS injections. A single SACS injection was applied in all patients. Mobilization was administered as a single session right after SACS injection. Patients’ evaluations were performed measuring active range of motion (AROM), visual analogue scale (VAS) during activity and rest, and Disabilities of Arm, Shoulder, and Hand Score (DASH) prior to treatment and in the first and fourth weeks following the treatment. Results Both groups showed significant improvement in terms of AROM, VAS, and DASH scores in each evaluation step (P < 0.05). Visual analogue scale activity in the first week was significantly better in Group 1 (P = 0.028). Also, flexion and abduction degrees showed significantly better outcomes in Group 1 (P = 0.007, P = 0.036). Conclusion Addition of single-session mobilization might provide rapid improvement in flexion and abduction as well as early pain relief following SACS injections.
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Affiliation(s)
- Fazil Kulakli
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Ilker Ilhanli
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Ilker Fatih Sari
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Adem Türköz
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Canan Çelik
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Giresun University, Giresun, Turkey
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Paolucci T, Pezzi L, Centra MA, Porreca A, Barbato C, Bellomo RG, Saggini R. Effects of capacitive and resistive electric transfer therapy in patients with painful shoulder impingement syndrome: a comparative study. J Int Med Res 2019; 48:300060519883090. [PMID: 31680597 PMCID: PMC7783264 DOI: 10.1177/0300060519883090] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective Capacitive and resistive electric transfer therapy (CARE) reduces pain and
improves quality of life for many orthopaedic degenerative and inflammatory
disorders. The research aim was to determine the effects of CARE on painful
shoulder. The outcomes were pain reduction and recovery of shoulder
function. Methods A retrospective, observational case-control study was conducted. Participants
were 46 patients (22 in the CARE group and 24 in the SHAM group). Clinical
data, pain (visual analogic scale, VAS) and functional scale scores
(Disabilities of the Arm, Shoulder and Hand scale, and Constant–Murley
Scale) were measured at baseline T0 (before treatment), T1 (after treatment)
and follow-up T2 (2 months after the end of the treatment). Results VAS scores in the CARE group improved from 7.23 ± 1.11 at baseline to
2.68 ± 0.99 at follow-up. The SHAM group did not experience any improvement.
Similarly, functional scale scores improved in the CARE group compared with
the SHAM group. Conclusion Considering the small number of sessions needed, low cost and long-term
benefits, CARE could be a useful therapeutic option for the conservative
management of shoulder pain to restore pain-free and powerful movement to
the shoulder joint.
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Affiliation(s)
- T Paolucci
- University G. d'Annunzio Chieti, Department of Medical and Oral Sciences and Biotechnologies, Chieti-Pescara, Italy
| | - L Pezzi
- University G. d'Annunzio Chieti, Department of Medical and Oral Sciences and Biotechnologies, Chieti-Pescara, Italy
| | - M A Centra
- University G. d'Annunzio Chieti, Department of Medical and Oral Sciences and Biotechnologies, Chieti-Pescara, Italy
| | - A Porreca
- Department of Economics, 'Gabriele d'Annunzio' University, Chieti-Pescara, Italy
| | - C Barbato
- University of Study of Urbino Carlo Bo, Department of Biomolecular Sciences, Urbino, Italy
| | - R G Bellomo
- University of Study of Urbino Carlo Bo, Department of Biomolecular Sciences, Urbino, Italy
| | - R Saggini
- University G. d'Annunzio Chieti, Department of Medical and Oral Sciences and Biotechnologies, Chieti-Pescara, Italy
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Rueckl K, Ernstbrunner L, Reichel T, Bouaicha S, Barthel T, Rudert M, Plumhoff P. [Indications and techniques of arthroscopic anterior and lateral acromioplasty]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 31:351-370. [PMID: 31363791 DOI: 10.1007/s00064-019-0620-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/12/2019] [Accepted: 04/22/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Arthroscopic anterior acromioplasty (AAAP) for treatment of symptomatic subacromial spur. Arthroscopic lateral acromioplasty (ALAP) to reduce a pathological critical shoulder angle (CSA) and prevent rotator cuff re-tear after reconstruction. INDICATIONS AAAP is indicated for acromial impingement due to an anterolateral acromial spur with or without bursa-sided rotator cuff lesion. ALAP is indicated concomitant to arthroscopic rotator cuff repair if the CSA is pathologically increased. RELATIVE CONTRAINDICATIONS Irreparable rotator cuff tear with acetabularization of the acromion due to anterosuperior escape of the humeral head or symptomatic os acromiale can contraindicate for AAAP. Dehiscence of the origin of the deltoid muscle or symptomatic os acromiale can contraindicate for ALAP. SURGICAL TECHNIQUE To preform AAAP, arthroscopic subacromial decompression is followed by anterolateral resection of an acromion spur or ossification of the coracoacromial ligament. To perform ALAP, arthroscopic subacromial decompression and reconstruction of a rotator cuff-tear is followed by reduction of a pathologically increased CSA by resection of the lateral edge of the acromion. POSTOPERATIVE MANAGEMENT After isolated AAAP, physiotherapy can be performed without restriction. After AAAP or ALAP combined with rotator cuff repair, immobilization in a brace is recommended. The use of pain medication should be standardized and adapted to individual pain levels.
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Affiliation(s)
- Kilian Rueckl
- Lehrstuhl für Orthopädie, König-Ludwig-Haus, Universität Würzburg, Brettreichstraße 11, 97074, Würzburg, Deutschland.
| | - Lukas Ernstbrunner
- Universitätsklinik Balgrist, Abteilung für Schulter- & Ellbogenchirurgie, Universität Zürich, Forchstrasse 340, 8008, Zürich, Schweiz
| | - Thomas Reichel
- Lehrstuhl für Orthopädie, König-Ludwig-Haus, Universität Würzburg, Brettreichstraße 11, 97074, Würzburg, Deutschland
| | - Samy Bouaicha
- Universitätsklinik Balgrist, Abteilung für Schulter- & Ellbogenchirurgie, Universität Zürich, Forchstrasse 340, 8008, Zürich, Schweiz
| | - Thomas Barthel
- Lehrstuhl für Orthopädie, König-Ludwig-Haus, Universität Würzburg, Brettreichstraße 11, 97074, Würzburg, Deutschland
| | - Maximilian Rudert
- Lehrstuhl für Orthopädie, König-Ludwig-Haus, Universität Würzburg, Brettreichstraße 11, 97074, Würzburg, Deutschland
| | - Piet Plumhoff
- Lehrstuhl für Orthopädie, König-Ludwig-Haus, Universität Würzburg, Brettreichstraße 11, 97074, Würzburg, Deutschland
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Bacha R, Manzoor I, Gilani SA. Sonographic presentation of rice bodies in subacromial-subdeltoid chronic bursitis. Ultrasound J 2019; 11:16. [PMID: 31359207 PMCID: PMC6643005 DOI: 10.1186/s13089-019-0130-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 07/10/2019] [Indexed: 11/21/2022] Open
Abstract
Background subacromial-subdeltoid chronic bursitis is one of the main causes of shoulder pain syndrome. There are various causes of shoulder pain syndrome including chronic bursitis. The sonographic appearances of chronic bursitis vary from patient to patient, depending upon the underlying cause. However, rice bodies are the rare sonographic presentation among them. Rice bodies can be associated with atypical mycobacterial tenosynovitis, bursitis, mycobacterium tuberculosis and infections, but very rarely occur in the chronic subacromial-subdeltoid bursitis. Its unique sonographic presentation makes it easy to be diagnosed confidently, but it is difficult to be recognized, interpret and distinguish from other pathologies due to its rare occurrence. It is therefore intended to present this rare and interesting sonographic presentation of chronic subacromial-subdeltoid bursitis as a case report. Case-presentation A 36-year-old male suffering from swelling and pain on his left shoulder for 6 months came to the clinic with Grade-3 impingement syndrome. Free-floating echogenic rice bodies were identified in the subacromial-subdeltoid bursa during ultrasound examination, which was also confirmed with Magnetic resonance imaging (MRI) and serological tests of the specimen after surgery. Conclusion The unique sonographic presentation of rice bodies in the chronic subacromial-subdeltoid bursitis makes it easy to be diagnosed confidently, but it is difficult to be recognized, due to its rare occurrence. Electronic supplementary material The online version of this article (10.1186/s13089-019-0130-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Raham Bacha
- University Institute of Radiological Sciences and Medical Imaging Technologies (UIRSMIT), Faculty of Allied Health Sciences (FAHS), The University of Lahore, Lahore, Pakistan
| | - Iqra Manzoor
- University Institute of Radiological Sciences and Medical Imaging Technologies (UIRSMIT), The University of Lahore, G 10\2 Canal Berg, Lahore, 54000, Pakistan.
| | - Syed Amir Gilani
- Dean Faculty of Allied Health Sciences (FAHS), The University of Lahore, Lahore, Pakistan
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Niewald M, Micke O, Mücke R. Don't Forget Radiotherapy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:342-343. [PMID: 29875058 PMCID: PMC5997889 DOI: 10.3238/arztebl.2018.0342c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Popert U. If Possible Treat Without Surgery. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:342. [PMID: 29875056 DOI: 10.3238/arztebl.2018.0342a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hien NM. Motion Sequence Disrupted. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:342. [PMID: 29875057 PMCID: PMC5997887 DOI: 10.3238/arztebl.2018.0342b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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H. Brunner U. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:343-344. [PMID: 29875059 PMCID: PMC5997885 DOI: 10.3238/arztebl.2018.0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Ulrich H. Brunner
- *Abteilung für Unfall-, Schulter- und Handchirurgie, Krankenhaus Agatharied GmbH, Hausham
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