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 simulate anterosuperior instabil ity of the shoulder by a combination of massive irreparable rotator cuff tears and coracoacromial arch disruption in cadaveric specimens, use proximally based conjoined tendon transfer forcoracoacromial l igament (CAL) reconstruction to restrain against superior humeral subluxation, and investigate its feasibility and biomechanics property. Methods Nine donated male-adult and fresh-frozen cadaveric glenohumeral joints were applied to mimic a massive irreparable rotator cuff tear in each shoulder. The integrity of the rotator cuff tendons and morphology of the CAL were visually inspected in the course of specimen preparation. Cal ipers were used to measure the length of the CAL’s length of the medial and the lateral bands, the width of coracoid process and the acromion attachment, and the thickness in the middle, as well as the length, width and thickness of the conjoined tendon and the lateral half of the removed conjoined tendon. The glenohumeral joints were positioned in a combination of 30° extension, 0° abduction and 30° external rotation. The value of anterosuperior humeral head translation was measured after the appl ication of a 50 N axial compressive load to the humeral shaft under 4 sequential scenarios: intact CAL, subperiosteal CAL release, CAL anatomic reattachment, entire CAL excision after lateral half of the proximally based conjoined tendon transfer for CAL reconstruction. Results All specimens had an intact rotator cuff on gross inspection. CAL morphology revealed 1 Y-shaped, 4 quadrangular, and 4 broad l igaments. The length of the medial and lateral bands of the CAL was (28.91 ± 5.56) mm and (31.90 ± 4.21) mm, respectively; the width of coracoid process and acromion attachment of the CAL was (26.80 ± 10.24) mm and (15.86 ± 2.28) mm, respectively; and the thickness of middle part of the CAL was (1.61 ± 0.36) mm. The length, width, and thickness of the proximal part of the proximally based conjoined tendon was (84.91 ± 9.42), (19.74 ± 1.77), and (2.09 ± 0.45) mm, respectively. The length and width of the removed lateral half of the proximally conjoined tendon was (42.67 ± 3.10) mm and (9.89 ± 0.93) mm, respectively. The anterosuperior humeral head translation was intact CAL (8.13 ± 1.99) mm, subperiosteal CAL release (9.68 ± 1.97) mm, CAL anatomic reattachment (8.57 ± 1.97) mm, and the lateral half of the proximally conjoined tendon transfer for CAL reconstruction (8.59 ± 2.06) mm. A significant increase in anterosuperior migration was found after subperiosteal CAL release was compared with intact CAL (P lt; 0.05). The translation after CAL anatomic reattachment and lateral half of the proximally conjoined tendon transfer for CAL reconstruction increased over intact CAL, though no significance was found (P gt; 0.05); when they were compared with subperiosteal CAL release, the migration decreased significantly (P lt; 0.05). The translation of lateral half of the proximally conjoined tendon transfer for CAL reconstruction increased over CAL anatomic reattachment, but no significance was evident (P gt; 0.05). Conclusion The CAL should be preserved or reconstructed as far as possible during subacromial decompression, rotator cuff tears repair, and hemiarthroplasty for patients with massive rotator cuff deficiency. If preservation or the insertion reattachment after subperiosteal release from acromion of the CAL of the CAL is impossible, or CAL is entirely resected becauseof previous operation, the use of the lateral half of the proximally based conjoined tendon transfer for CAL reconstruction isfeasible.
Objective To investigate the mid-term effectiveness of arthroscopic Bankart repair for recurrent anterior shoulder dislocation. Methods The clinical data of 107 patients with recurrent anterior shoulder dislocation who met the inclusion criteria between January 2017 and June 2021 was retrospectively analyzed, and all patients underwent arthroscopic Bankart repair. There were 88 males and 19 females. The age of the primary dislocation ranged from 13 to 48 years (mean, 23.3 years). The number of preoperative dislocations was 2-160 times (median, 7 times). The duration of preoperative instability was 0.2-240.0 months (median, 36.0 months). The mean age at operation was 28.2 years (range, 16-61 years). There were 43 cases of left shoulder and 64 cases of right shoulder. The proportion of glenoid defects in 63 patients was 1.7%-16.1% (mean, 8.1%). MRI showed that none of the patients had rotator cuff tears or shoulder stiffness. The CT three-dimensional reconstruction was performed at 1 day after operation to evaluate the distribution of implanted anchors and the occurrence of glenoid split fracture and whether there were nails pullout at the implant site. The postoperative complications were observed, and the pain and function of the shoulder were evaluated by visual analogue scale (VAS) score, Rowe score, Constant-Murley score, and American Shoulder and Elbow Surgeons (ASES) score. The recurrence of instability, the results of apprehension test, the number of patients who returned to preoperative sports level, and the satisfaction rate of patients were recorded. Results All patients were successfully operated and were followed up 20-73 months (mean, 41.5 months). All incisions healed by first intention. The CT three-dimensional reconstruction at 1 day after operation showed that the anchors were located at the 2 : 00-5 : 30 positions of the glenoid, and there was no glenoid split fracture or nails pullout at the implant site. At last follow-up, VAS score was significantly lower than that before operation, and Rowe score, Constant-Murley score, and ASES score were significantly higher than those before operation (P<0.05). Seven patients (6.5%) had recurrence of anterior shoulder dislocation at 23-55 months (mean, 39.9 months) after operation, including 6 cases of dislocation and 1 case of subluxation. At last follow-up, 51 patients (47.7%) returned to preoperative sports level, and 11 patients (10.3%) had a positive apprehension test. The patients’ satisfaction rate was 90.7% (97/107). Among the 10 patients who were not satisfied with the surgical effectiveness, 7 patients had postoperative recurrence of instability, and 3 patients felt that they did not return to preoperative sports level. Conclusion Arthroscopic Bankart repair has good mid-term effectiveness in patients with recurrent anterior shoulder dislocations, minimal or no glenohumeral bone defects and low sports need.
ObjectiveTo review the research progress of the biomechanical study of the Bristow-Latarjet procedure for anterior shoulder dislocation. MethodsThe related biomechanical literature of Bristow-Latarjet procedure for anterior shoulder dislocation was extensively reviewed and summarized. ResultsThe current literature suggests that when performing Bristow-Latarjet procedure, care should be taken to fix the bone block edge flush with the glenoid in the sagittal plane in the direction where the rupture of the joint capsule occurs. If traditional screw fixation is used, a double-cortical screw fixation should be applied, while details such as screw material have less influence on the biomechanical characteristics. Cortical button fixation is slightly inferior to screws in terms of biomechanical performance. The most frequent site of postoperative bone resorption is the proximal-medial part of the bone block, and the cause of bone resorption at this site may be related to the stress shielding caused by the screw. ConclusionThere is no detailed standardized guidance for bone block fixation. The optimal clinical treatment plan for different degrees of injury, the factors influencing postoperative bone healing and remodeling, and the postoperative osteoarticular surface pressure still need to be further clarified by high-quality biomechanical studies.
ObjectiveTo investigate the effectiveness of suspensory external fixation technique in treatment of proximal humeral fractures.MethodsBetween August 2013 and October 2018, 14 patients with proximal humeral fractures were treated with suspensory external fixation technique. There were 10 males and 4 females with an average age of 55.9 years (range, 43-76 years). There were 10 cases of falling injury and 4 cases of traffic accident injury. Among them, there were 9 cases of Neer type Ⅲ and 5 cases of Neer type Ⅳ. The time from injury to operation was 3-7 days (mean, 4.6 days). Nine cases were complicated with osteoporosis. The preoperative visual analogue scale (VAS) score was 6.1±1.2. The effectiveness was comprehensively evaluated by hospital stay, fracture healing time, removal time of external fixator, postoperative complications, VAS score, and Neer score of shoulder joint function.ResultsAll operations were successfully completed, and the hospital stay was 6-14 days, with an average of 9.4 days. All the incisions healed by first intention, and no infection or other complications occurred. All patients were followed up 16-60 months (mean, 35.4 months). X-ray films examination showed that all fractures healed, the healing time was 4-7 months (mean, 4.9 months). The removal time of external fixator was 5-8 months (mean, 6.3 months). VAS scores were 1.5±0.8 at 1 month after operation and 1.0±0.9 at last follow-up, both of which were significantly improved when compared with preoperative score, the differences were significant between different time points (P<0.05). Neer score of shoulder joint function was 75-100 (mean, 91.1); 9 cases were excellent, 4 cases were good, and 1 case was fair. The excellent and good rate was 92.9%. During follow-up, there was no adverse events such as acromion impingement, nonunion, or pseudoarthrosis.ConclusionFor proximal humeral fractures, the suspensory external fixation technique is a simple and reliable treatment method that can significantly improve joint function.
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.
Objective To assess the effectiveness of suture button fixation Latarjet procedure under total arthroscopy for anterior shoulder instability with severe bone defects. MethodsThe clinical data of 15 patients with severe bone defects and anterior shoulder instability treated with suture button fixation Latarjet procedure under total arthroscopy between June 2020 and February 2023 was retrospectively analyzed, including 11 males and 4 females, with an average age of 31.1 years (range, 20-54 years). Three-dimensional CT showed that the average glenoid bone defect was 24.4% (range, 16.3%-35.2%). The average number of shoulder dislocation was 4.2 times (range, 3-8 times). The disease duration ranged from 6 to 21 months with an average of 10.6 months. The operation time and intraoperative blood loss were recorded. The pain relief was evaluated by visual analogue scale (VAS) score, and the functional recovery of shoulder joint was evaluated by Rowe score, Walch-Duplay score, and American Association for Shoulder and Elbow Surgery (ASES) score before and after operation. The range of motion (ROM) of the shoulder joint was assessed, including active flexion, lateral external rotation, abduction 90° external rotation, and internal rotation. Three-dimensional CT was performed at 6 months after operation and at last follow-up to observe the absorption of bone graft, the position of bone graft and glenoid, and the healing of bone graft. Results The operation was successfully completed in all patients. The operation time was 85-195 minutes, with an average of 123.0 minutes. The intraoperative blood loss was 20-75 mL, with an average of 26.5 mL. All patients were followed up 13-32 months, with an average of 18.7 months. During the follow-up, there was no serious complication such as shoulder joint infection, joint stiffness, or vascular and nerve injury. One patient had partial absorption of the transplanted bone and bone nonunion at 3 months after operation, but the pain of the shoulder joint relieved at last follow-up, and no redislocation of the shoulder joint occurred; no obvious bone fracture or dislocation of the shoulder joint was found in the other patients. Bone union was achieved at 6 months during follow-up. At last follow-up, the VAS score, Rowe score, Walch-Duplay score, and ASES score significantly improved when compared with those before operation (P<0.05), while the ROM of active flexion, lateral external rotation, abduction 90° external rotation, and internal rotation of the shoulder joint was not significantly different from those before operation (P>0.05).ConclusionSuture button fixation Latarjet procedure under total arthroscopy can improve shoulder joint function in patients with severe anterior shoulder instability caused by bone defects, and imaging also indicates satisfactory placement of transplanted bone blocks.
Objective To evaluate the efficacy and safety of different site injection of compound betamethasone injection, ropivacaine and sodium hyaluronate for treatment of frozen shoulder at early stage. Methods A Total of 68 participants were included from May 2015 to May 2017 and randomly assigned to the glenohumeral joint and subacromial space group (IA+SA group, n=34) and glenohumeral joint group (IA group, n=34). In the IA+SA group, a solution of 1 mL corticosteroid, 6 mL ropivacaine, 2 mL sodium hyaluronate, and 8 mL normal saline were prepared and injected to glenohumeral joint, and a solution of 1 mL corticosteroid, 2 mL ropivacaine, 2 mL sodium hyaluronate, and 2 mL normal saline were injected to subacromial space. In the IA group, participants were given the same dose of drugs to the glenohumeral joint. The Visual Analogue Scale (VAS) score and Constant-Murley score were used to assess pain and function of shoulder respectively. The change of VAS score and Constant-Murley score after treatment were used to evaluate pain relief and shoulder function improvement. Results Of the 68 participants, two in each group were lost to follow up and one in the IA+SA group dropped out. There was significant effect on pain relief and shoulder function improvement on all measurement in both groups (P<0.001) during the 12 weeks after treatment. In the IA group, group- by-time interaction were significant for pain relief at 6 and 12 weeks comparing with that at 3 weeks (P<0.001), while no significant difference at 6 weeks comparing with 12 weeks. In the IA+SA group, group-by-time interaction were significant for pain relief at all endpoints (3 weeksvs. 6 weeks: P<0.001; 3 weeksvs. 12 weeks: P<0.001; 3 weeksvs. 6 weeks: P=0.034). In both groups, there was significant effect on shoulder function improvement when compared at each endpoint within group (P<0.001). Between-group comparison revealed no significant effect on pain relief (P=0.386) or shoulder function improvement (P=0.685). There was also no significant effect on pain relief (3 weeks: P=0.898; 6 weeks: P=0.448; 12 weeks: P=0.216) and shoulder function improvement (3 weeks: P=0.120; 6 weeks: P=0.152; 12 weeks: P=0.868) at each same endpoint. Conclusions Different site injection can effectively release pain and improve shoulder function for the patients with frozen shoulder at early stage and be well tolerated. However, it is not found that two site injection is inferior to single site injection.
ObjectivesTo systematically review the epidemiological characteristics of post-stroke shoulder pain (PSSP).MethodsPubMed, WanFang Data, CNKI, EMbase, The Cochrane Library and SinoMed databases were electronically searched to collect studies on the morbidity of PSSP from inception to November 30th, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 15.0 software.ResultsA total of 13 studies were included. The total sample size was 3 514, including 1 357 patients with PSSP. The results of meta-analysis showed that the total morbidity of PSSP was 45.0% with 95%CI 32.0% to 58.0%. The results of subgroup analysis showed that the morbidity of PSSP was 55.5% (95%CI 48.1% to 63.0%) prior to 2010 and 40.6% (95%CI 28.3% to 52.9%) after 2010, respectively. The morbidity of PSSP in Asia was 61.2% (95%CI 51.3% to 71.1%), and in Europe and America was 18.4% (95%CI 9.9% to 26.9%), respectively.ConclusionsCurrent evidence suggests that PSSP has high morbidity, and it may be affected by regional factors. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo investigate the correlation between glenohumeral joint congruence and stability in recurrent shoulder dislocations. Methods Eighty-nine patients (89 sides) with recurrent shoulder dislocation admitted between June 2022 and June 2023 and met the selection criteria were included as study subjects. There were 36 males and 53 females with an average age of 44 years (range, 20-79 years). There were 40 cases of left shoulder and 49 cases of right shoulder. The shoulder joints dislocated 2-6 times, with an average of 3 times. The three-dimensional models of the humeral head and scapular glenoid were reconstructed using Mimics 20.0 software based on CT scanning images. The glenoid track (GT), inclusion index, chimerism index, fit index, and Hill-Sachs interval (HSI) were measured, and the degree of on/off track was judged (K value, the difference between HSI and GT). Multiple linear regression was used to analyze the correlation between the degree of on/off track (K value) and inclusion index, chimerism index, and fit index. ResultsMultiple linear regression analysis showed that the K value had no correlation with the inclusion index (P>0.05), and was positively correlated with the chimerism index and the fit index (P<0.05). Regression equation was K=–24.898+35.982×inclusion index+8.280×fit index, R2=0.084. ConclusionHumeral head and scapular glenoid bony area and curvature are associated with shoulder joint stability in recurrent shoulder dislocations. Increased humeral head bony area, decreased scapular glenoid bony area, increased humeral head curvature, and decreased scapular glenoid curvature are risk factors for glenohumeral joint stability.