Effectiveness of Ultrasound in Evaluation of Fatty Infiltration in Rotator Cuff Muscles

BACKGROUND: This study aimed to verify the diagnostic performance of Ultrasonography (US) in the evaluation of fatty infiltration (FI) in rotator cuff muscles and to analyze the diagnostic values of each measurement component.METHODS: The degree of FI in 108 shoulders was assessed by magnetic resonance imaging (MRI) and US. MRI findings were graded by the Goutallier classification. US findings were graded by the Strobel method. Agreement between MRI and US findings was evaluated. The sensitivity and specificity for detecting FI and intraobserver reliabilities were also assessed.RESULTS: US grading of the infraspinatus based on short-axis architecture showed good agreement (κ = 0.62). US grading-based on architecture showed good agreement for both supraspinatus and infraspinatus in long- and short-axis scans (supraspinatus, κ = 0.63; infraspinatus, κ = 0.68), while that based on echogenicity showed moderate agreement (supraspinatus, κ = 0.51; infraspinatus, κ = 0.50). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of detecting advanced FI were significant in both axes.CONCLUSIONS: US is effective for detecting advanced FI in the rotator cuff muscles. US can assess the infraspinatus more accurately than the supraspinatus, and architecture is a more decisive component of FI status than echogenicity.

The Characteristics of Shoulder Muscles in Archery Athletes

BACKGROUND: This study evaluated the shoulder girdle muscle characteristics of elite archery athletes and provides suggestions for archery training programs. METHODS: This study enrolled 15 cases of high level archery athletes (7 males, 8 females) and 30 cases of (15 males, 15 females) sex, age-matched, healthy, non-athletic individuals. We measured peak torques of flexion (FL), extension (EX), abduction (ABD), adduction (ADD), external rotation (ER) and internal rotation (IR) of both shoulders at an angular velocity of 30°/sec, 60°/sec, and 180°/sec. The peak torques and peak torque ratios of FL/EX, ABD/ADD, and ER/IR of the two groups were compared. RESULTS: The archer group had a greater peak torque of IR and ADD, but only in the left shoulder (p < 0.05). In the same group, both shoulders had greater peak torque of EX and lower peak torque of FL. The peak torque ratios of FL/EX of both shoulders were significantly lower in the archer group at all three angular velocities (p < 0.05). The peak torque ratios of ABD/ADD were significantly greater in only the left shoulder of the archer group (p < 0.05). CONCLUSIONS: The prominent characteristics of the shoulder girdle muscles of an elite archer are stronger adductor muscles of the bow shoulder and stronger extensors of both shoulders, as compared to healthy, non-athletic individuals. These muscle groups of the shoulder probably contribute a major role in maintaining the accuracy and stability during archery shooting. Hence, a training program that selectively enhances the adductor and extensor muscles could prove helpful in enhancing the archery skills of the athlete.

Postpartum Sacral Stress Fracture Mimicking Lumbar Radiculopathy in a Patient With Pregnancy-Associated Osteoporosis

Postpartum sacral fracture is relatively rare, and its diagnosis is often delayed. We herein report such a case of a 28-year-old patient who presented with an insidious-onset lower back pain, left buttock pain, and radicular symptoms mimicking lumbar radiculopathy. Laboratory tests showed a decreased 25-hydroxy vitamin D level, and the bone mineral densitometry of both femurs was below the expected range. Plain radiographs of the lumbar spine and pelvis showed no definite abnormality, but lumbosacral spinal magnetic resonance imaging identified a left sacral fracture. Symptoms were alleviated with rest and oral analgesic treatment.

The Effects of Visual and Haptic Vertical Stimulation on Standing Balance in Stroke Patients

OBJECTIVE: To explore the effect of visual and haptic vertical stimulation on standing balance in post-stroke patients. METHODS: Twenty-five post-stroke patients were recruited. We measured left/right standing pressure differences and the center of pressure (COP) parameters for each patient under three different conditions: no stimulation, visual, and haptic stimulated conditions. First, patients stood on a posturography platform with their eyes blindfolded. After a rest period, the patients stood on the same platform with their eyes fixed to a 1.5-m luminous rod, which was placed at a vertical position in front of the patients. After another rest period, the patients again stood touching a vertically placed long rod in their non-hemiplegic hand with their eyes blindfolded. We collected the signals from the feet in each condition and obtained the balance indices. RESULTS: Compared with the no stimulation condition, significant improvements were observed for most of the COP parameters including COP area, length, and velocity for both the visual and haptic vertical stimulation conditions (p0.01). CONCLUSION: Both visual and haptic vertical stimulation improved standing steadiness of post-stroke patients. Notably, visual vertical stimulation was more effective than haptic stimulation.

Effect of Botulinum Toxin A on Trismus after Pons Infarction: A case report

We report a 77-year-old woman with bilateral pons infarction who presented with severe trismus, which was responsive to botulinum toxin-A injection. She was unable to open her mouth and showed anterior displacement of her temporo-mandibular (TM) joint on MRI findings. She was fed via nasogastric tube because of mouth opening limitation. There was no improvement of her mouth opening after range of motion exercise. She underwent closed reduction of the TM joints under general anesthesia but there was no significant improvement. Electromyography studies revealed continuous muscle activities on masseter and temporalis muscles during mouth opening. Botulinum toxin-A (Botox(R)) was injected into both the masseter and left temporalis muscles under ultrasonographic guidance. There was some improvement in mouth opening at post-injection 5 days. The inter-incisal distance improved gradually, and she could start oral feeding after 18 days. She could maintain an inter-incisal distance of 1.8 cm with favorable response during post-injection 4 months.