Frozen shoulder is a common disease in orthopaedic clinic. The main clinical manifestations were shoulder joint pain and limited active and passive activity. However, the etiology and pathogenesis of frozen shoulder are not fully understood, so people can not choose the appropriate treatment plan. In recent years, there have been a lot of exploration on the pathogenesis and treatment measures of this disease at home and abroad, but there is no unified standard for the treatment of frozen shoulder. This article summarizes the treatment methods of frozen shoulder at home and abroad in recent years, analyzes the advantages and disadvantages of non-surgical treatment and surgical treatment, in order to provide assistance for clinical practice.
Objective To systematically evaluate the effect of arm sling on shoulder subluxation in stroke patients with hemiplegia. METHODS CNKI, Wanfang, VIP, PubMed, Web of Science, Embase, Cochrane Library, OVID, EBM Reviews, Best Practice, ACP Journal Club, and Practice Guidline were searched from establishment to March 2023. The literature on randomized controlled trials of arm sling on gait or balance in post-stroke patients with hemiplegia were included. RevMan 5.4.1 software was used for meta-analysis. Results A total of 13 articles were included, including 691 subjects, 343 in the experimental group, and 348 in the control group. The meta-analysis results showed that patients wearing the boom arm were effective in improving the recovery of upper extremity function [mean difference (MD)=8.12, 95% confidence interval (CI) (2.39, 11.60), P＜0.000 01], relieving pain due to shoulder subluxation [MD=−1.13, 95%CI (−1.70, −0.56), P=0.000 1], and enhancement of patients’ quality of life in daily activities [MD=15.07, 95%CI (3.24, 26.90), P=0.01], all of which were superior to the control group. However, there was no statistically significant difference between the two groups in terms of Apnea-Hypopnea Index [MD=−1.86, 95%CI (−3.79, 0.06), P=0.06], 6 min walking test [MD=−0.51, 95%CI (−18.52, 17.49), P=0.96], 10 meter walk time [MD=0.00, 95%CI (−0.06, 0.06), P=0.91], heart rate [MD=−0.22, 95%CI (−5.10, 4.27), P=0.93], and Berg balance scale [MD=−2.53, 95%CI (−8.17, 3.10), P=0.38]. Conclusion The use of arm sling can effectively improve patients’ quality of life, functional recovery of the upper limbs and reduce pain, providing an evidence-based basis for healthcare professionals to treat patients with proven treatment modalities.
In post-coronavirus disease 2019 era, people’s style of work and life have undergone major changes. The sedentary style of work and life, such as long-time office work, online meetings, home eating, online social interactions, and reduced range of activities, affect people’s physical and mental health. Neck and shoulder pain is one of the common symptoms. By combining the clinical practice experience of orthopedic medical experts in West China Hospital of Sichuan University, and reviewing a large number of literatures, this article summarized the definition, incidence, hazards, causes, evaluation and prevention of neck and shoulder pain in post-coronavirus disease 2019 era. It aimed to provide experience for the prevention and treatment of neck and shoulder pain in post-coronavirus disease 2019 era.
Objective To evaluate the early-term effectiveness of Latarjet procedure with double EndoButtons fixation for recurrent anterior shoulder dislocation by coracoid osteotomy with preserving coracoacromial ligament. Methods Between January 2021 and June 2023, 19 patients with recurrent anterior shoulder dislocations were treated by arthroscopic Latarjet procedure with double EndoButtons fixation, all of which underwent coracoid osteotomy with preserving the coracoacromial ligament. There were 11 males and 8 females, with an average age of 23.3 years (range, 17-32 years). Shoulder dislocations ranged from 3 to 11 times, with an average of 6.4 times. The disease duration ranged from 3 to 35 months, with an average of 12.9 months. All apprehension tests were positive. Imaging examination showed that the defect width of the ipsilateral glenoid bone was 13%-26%, with an average of 19.8%. After operation, the shoulder range of motion was examined, including flexion lift, lateral external rotation, extension 90° external rotation, and internal rotation. Shoulder joint function was evaluated by Walch-Duplay score, American Association for Shoulder and Elbow Surgery (ASES) score, and Rowe score. Imaging examinations were taken to observe the position and shaping of coracoid. Results All incisions healed by first intention and no nerve or vessel injury occurred. All patients were followed up 9-24 months (mean, 14.5 months). There was no recurrence of shoulder dislocation and the apprehension tests were negative during follow-up. There was no significant difference in the shoulder range of motion (flexion lift, lateral external rotation, extension 90° external rotation, and internal rotation) between preoperation and at last follow-up (P>0.05). The Walch-Duplay score, ASES score, and Rowe score significantly improved when compared with those before operation (P<0.05). Postoperative imaging showed that coracoid graft was at the same level with the glenoid in all cases; the center of coracoid graft was located between 3 to 5 o’clock. During follow-up, there was no glenohumeral joint degeneration, the acromiaohumeral distance was not reduced when compared with preoperation, and the coracoid bone gradually formed concentric circles with the humeral head. Conclusion The Latarjet procedure with double EndoButtons fixation can effectively treat recurrent anterior shoulder dislocation by coracoid osteotomy with preserving coracoacromial ligament, and the early-term effectiveness is satisfactory.
Objective To investigate the effectiveness of double EndoButton suture fixation Latarjet procedure in the treatment of shoulder anterior dislocation with glenoid bone defect caused by military training injuries.MethodsThe clinical data of 14 patients with anterior shoulder dislocation with glenoid bone defect due to military training injuries who met the selection criteria and admitted between August 2021 and December 2022 were retrospectively analyzed. All patients were male, the age ranged from 21 to 38 years, with an average of 26.8 years. The time from initial dislocation to operation was 6-15 months, with an average of 10.2 months. Anterior shoulder dislocation occurred 5-12 times, with an average of 8.2 times. All glenoid bone defects were more than 10%, including 5 cases of 10%-15%, 8 cases of 15%-20%, and 1 case of 24%. All patients were treated by double EndoButton suture fixation Latarjet procedure. The operation time and complications were recorded. The shoulder function and pain were evaluated by the American Association for Shoulder and Elbow Surgery (ASES) score, Rowe score, Instability Severity Index Score (ISIS), and visual analogue scale (VAS) score before and after operation. The range of motion of the shoulder was recorded, including forward flexion, 0° external rotation, and abduction 90° external rotation. The position, healing, and resorption of the bone mass were evaluated by three-dimensional CT of shoulder joint after operation. Results All patients successfully completed the operation, and the operation time was 100-150 minutes, with an average of 119.7 minutes. There was no complications such as infection, vascular and nerve injury. All patients were followed up 12-20 months, with an average of 15.6 months. During the follow-up, 4 patients had bone mass separation, absorption, and recurrent anterior dislocation, and the shoulder joint fear test was positive. Imaging of the remaining patients showed that the bone mass healed well, no anterior dislocation recurrence occurred, and the healing time was 3-7 months (mean, 4.7 months). At last follow-up, the range of motion, ASES score, Rowe score, ISIS score, and VAS score of the patients significantly improved when compared with those before operation (P<0.05). ConclusionThe effectiveness of double EndoButton suture fixation Latarjet procedure for the treatment of anterior shoulder dislocation with glenoid bone defect caused by military training injury is satisfactory.
Objective To evaluate the short-term effectiveness of modified arthroscopic Latarjet procedure with double EndoButtons for recurrent anterior shoulder dislocation. Methods Between January 2019 and November 2020, 36 patients with recurrent anterior shoulder dislocation were treated by modified arthroscopic Latarjet procedure with double EndoButtons. There were 26 males and 10 females, with an average age of 27.8 years (range, 18-36 years). The number of shoulder dislocations ranged from 3 to 12 times, with an average of 6.5 times. The disease duration ranged from 5 to 36 months, with an average of 16.2 months. Preoperative shoulder fear test was positive, and the Beighton score of joint relaxation was 0-4, with an average of 1.3. Imaging examination showed that the defect width of the ipsilateral glenoid bone was 16%-28%, with an average of 21.5%. Postoperative complications, recurrent dislocation, subluxation, and instability of shoulder joint were recorded. Shoulder range of motion was examined, including forward flexion, external rotation at side, external rotation at 90° abduction, and internal rotation. Shoulder joint function was evaluated by Walch-Duplay score, American Association for Shoulder and Elbow Surgery Score (ASES), and ROWE score. X-ray film and CT images were taken to observe the shaping of coracoid process graft. Results All incisions healed by first intention, and no vascular or nerve injury occurred. All patients were followed up 12-28 months, with an average of 19.9 months. During follow-up, no shoulder dislocation recurred, and shoulder fear test was negative. At last follow-up, there was no significant difference in shoulder forward flexion, external rotation at side, external rotation at 90° abduction, and internal rotation when compared with preoperative values (P>0.05). The Walch-Duplay score, ASES score, and ROWE score of shoulder function significantly improved (P<0.05). Postoperative imaging examination showed that coracoid process graft was at the same level with the glenoid in 33 cases (91.7%), medial in 1 case (2.8%), and lateral in 2 cases (5.6%); the center of coracoid process graft was mainly located between 3 to 5 o’clock in 33 cases (91.7%), higher than 3 o’clock in 1 case (2.8%), and lower than 5 o’clock in 2 cases (5.6%). There was no obvious glenohumeral joint degeneration during follow-up, and the coracoid process graft gradually formed concentric circles with the humeral head. Conclusion The modified arthroscopic Latarjet procedure with double EndoButtons can effectively treat recurrent anterior shoulder dislocation, and the short-term effectiveness is satisfactory, and the position of coracoid process graft is accurate.
Objective To investigate the synergistic interaction between the deltoid muscle and the rotator cuff muscle group in patients with rotator cuff tears (RCT), as well as the impact of the critical shoulder angle (CSA) on deltoid muscle strength. Methods A retrospective analysis was conducted on clinical data from 42 RCT patients who met the selection criteria and were treated between March 2022 and March 2023. There were 13 males and 29 females, with an age range of 42-77 years (mean, 60.5 years). Preoperative visual analogue scale (VAS) score was 6.0±1.6. CSA measurements were obtained from standard anteroposterior X-ray films before operation, and patients were divided into two groups based on CSA measurements: CSA>35° group (group A) and CSA≤35° group (group B). Handheld dynamometry was used to measure the muscle strength of various muscle group in the shoulder (including the supraspinatus, infraspinatus, subscapularis, and anterior, middle, and posterior bundles of the deltoid). The muscle strength of the unaffected side was compared to the affected side, and muscle imbalance indices were calculated. Muscle imbalance indices between male and female patients, dominant and non-dominant sides, and groups A and B were compared. Pearson correlation analysis was used to examine the relationship between muscle imbalance indices and CSA as well as VAS scores. Results Muscle strength in all muscle groups on the affected side was significantly lower than on the unaffected side (P<0.05). The muscle imbalance indices for the supraspinatus, subscapularis, infraspinatus, and anterior, middle, and posterior bundles of the deltoid were 14.8%±24.4%, 5.9%±9.7%, 7.2% (0, 9.1%), 17.2% (5.9%, 26.9%), 8.3%±21.3%, and 10.2% (2.8%, 15.4%), respectively. The muscle imbalance indices of the anterior bundle of the deltoid, supraspinatus, and infraspinatus were significantly lower in male patients compared to female patients (P<0.05); however, there was no significant difference in muscle imbalance indices among other muscle groups between male and female patients or between the dominant and non-dominant sides (P>0.05). There was a positive correlation between the muscle imbalance indices of infraspinatus and VAS score (P<0.05), and a positive correlation between CSA and the muscle imbalance indices of middle bundle of deltoid (P<0.05). There was no correlation between the muscle imbalance indices of other muscle groups and VAS score or CSA (P>0.05). Preoperative CSA ranged from 17.6° to 39.4°, with a mean of 31.1°. There were 9 cases in group A and 33 cases in group B. The muscle imbalance indices of the anterior bundle of the deltoid was significantly lower in group A compared to group B (P<0.05), while there was no significant difference in muscle imbalance indices among other muscle groups between group A and group B (P>0.05). ConclusionPatients with RCT have a phenomenon of deltoid muscle strength reduction, which is more pronounced in the population with a larger CSA.
ObjectiveTo investigate the surgical treatment and effectiveness of senile chronic shoulder dislocation. MethodsBetween October 2011 and April 2014, 7 elderly patients with chronic shoulder dislocation were treated. There were 2 males and 5 females with an average age of 74 years (range, 61-83 years). The causes of injuries were falling injury in 6 patients and traffic accident injury in 1 patient. The interval between injury and confirmed diagnosis was 4-12 weeks (mean, 6.7 weeks). Preoperative apprehension test and Dugas sign of the shoulder joint were positive. Before operation, the forward elevation, abduction, and external rotation were (50.7±8.4), (44.5±3.3), and (35.8±4.8)°, respectively; and internal rotation reached T6, T11, L4 in 1 case and reached T10, T12 in 2 cases separately. The Constant-Murley score and Neer score were 51.2±8.3 and 45.4±7.3, respectively. ResultsAll the incisions healed by first intention, and no complication of fracture or neurovascular injuries occurred. Seven patients were followed up 12-18 months (mean, 16 months), and no re-dislocation happened. At last follow-up, apprehension test and Dugas sign of the shoulder joint were negative. The forward elevation, abduction, and external rotation were significantly improved to (117.5±13.1), (72.0±4.6), and (39.0±3.4)° (t=-33.746, P=0.000; t=-30.614, P=0.000; t=-2.802, P=0.031); and internal rotation reached T6, T10, T12, and L3 in 1 case respectively, and T11 in 3 cases, showing no significant difference when compared with preoperative values (Ζ=-1.732, P=0.083). The Constant-Murley score and Neer score were significantly improved to 85.4±4.3 and 84.0±4.8 when compared with preoperative score (t=-21.016, P=0.000; t=-29.518, P=0.000). ConclusionSurgical treatment of senile chronic shoulder dislocation can improve the range of motion and function of the shoulder joint obviously.
Objective To review the research progress of ultrasound in the diagnosis and treatment of shoulder diseases, in order to provide a theoretical basis for the further development of ultrasound in shoulder surgery. Methods The recent literature on the application of ultrasound in the shoulder joint was extensively reviewed. The application of ultrasound in the diagnosis and treatment of shoulder joint diseases, and the advantages and disadvantages of ultrasound were analysed, and the development trend of ultrasound technology in the shoulder joint area was prospected. Results At present, the diagnosis of shoulder joint diseases mainly relies on MRI, however, with the development of ultrasound technology, ultrasound with the characteristics of convenient, reliable, and real-time dynamic evaluation is more and more recognized in the diagnosis process of shoulder joint diseases, combined with three-dimensional ultrasound, ultrasound intervention, and elastography can improve the accuracy, sensitivity, and specificity of the diagnosis, and is suitable for the diagnosis and treatment of various shoulder joint diseases, which is expected to carry out early prevention of shoulder joint diseases in the future and achieve more refined and minimally invasive treatment. ConclusionUltrasound technology has wide application prospect in shoulder joint diseases, but it is still in the developing stage, and the subjective dependence needs to be solved further.
Objective To evaluate the effectiveness and safety of intraoperative tranexamic acid use in total shoulder arthroplasty. Methods By searching Cochrane Library, PubMed, Embase, Chongqing VIP, Chinese National Knowledge Infrastructure, Wanfang Database from the establishment of the database to September 2021, randomized controlled trials of intraoperative tranexamic acid use in total shoulder arthroplasty were collected. Outcome indicators were total blood loss, postoperative drainage, hemoglobin reduction, length of operation, length of hospital stay, and formation of hematoma. RevMan 5.3 software was used for meta-analysis. Results Meta analysis results showed that the use of tranexamic acid can reduce total blood loss [weighted mean difference = −246.55 mL, 95% confidence interval (−335.36, −157.75) mL, P<0.000 01], reduce postoperative drainage [weighted mean difference = −134.05 mL, 95% confidence interval (−161.72, −106.38) mL, P<0.000 01], reduce hemoglobin reduction [weighted mean difference = −0.64 g/dL, 95% confidence interval (−0.91, −0.36) g/dL, P< 0.000 01], reduce hematoma formation [risk ratio=0.41, 95% confidence interval (0.22, 0.77), P=0.005]. There was no statistically significant difference in the length of operation and length of hospitalization between patients who used tranexamic acid and those who did not use tranexamic acid (P>0.05). Conclusions Tranexamic acid is effective and safe for patients undergoing total shoulder arthroplasty. It can reduce perioperative bleeding and hematoma formation without increasing the length of surgery and hospitalization.