Effects of total shoulder arthroscopy versus small-incision rotator cuff repair for rotator cuff injury / 中国基层医药

Objective:To investigate the effects of total shoulder arthroscopy versus small-incision rotator cuff repair on shoulder range of motion, postoperative pain, and complications in patients with rotator cuff injury. Methods:The clinical data of 106 patients with rotator cuff injuries treated in Yiwu Central Hospital between June 2018 and July 2021 were retrospectively analyzed. These patients were divided into an observation group and a control group according to different treatment regimens, with 53 patients in each group. The control group underwent arthroscopic small-incision rotator cuff repair. The observation group underwent total shoulder arthroscopy. Perioperative indicators, pain (Visual Analogue Scale score) before surgery and 1, 3, and 6 months after surgery, shoulder range of motion and shoulder-elbow function before surgery, and 3 and 6 months after surgery and postoperative complications were compared between the two groups.Results:Operative time in the observation group was significantly longer than that in the control group [(98.67 ± 12.31) minutes vs. (85.72 ± 10.53) minutes, t = 5.82, P < 0.01). Intraoperative blood loss, postoperative passive shoulder expansion time, and hospital stay in the observation group were (28.66 ± 3.12) mL, (5.61 ± 1.03) days, and (14.17 ± 2.26) days, which were significantly shorter than (37.68 ± 3.59) mL, (7.22 ± 1.41) days and (17.21 ± 3.04) days in the control group ( t = 13.81, 6.71, 5.86, all P < 0.01). After surgery, the Visual Analogue Scale score in each group significantly decreased compared with that before surgery (both P < 0.05). At 1, 3, and 6 months after surgery, the Visual Analogue Scale score in the observation group was (2.46 ± 0.63) points, (1.53 ± 0.42) points, and (1.03 ± 0.26) points, respectively, which were significantly lower than (3.04 ± 0.74) points, (1.84 ± 0.51) points, and (1.21 ± 0.34) points in the control group ( t = 4.35, 3.42, 3.06, all P < 0.01). At 3 and 6 months after surgery, the ranges of motion of shoulder abduction, external rotation, and internal rotation in each group significantly increased compared with those before surgery (all P < 0.05). The scores of American Shoulder and Elbow Surgeons and the University of California Los Angeles in each group were significantly increased compared with those before surgery (both P < 0.05). After treatment, there were no significant differences in the scores of American Shoulder and Elbow Surgeons and the University of California Los Angeles between the two groups (both P < 0.05). By 6 months after surgery, the incidence of complications in the control group was 3.77%. No obvious complications were observed in the observation group. There was no significant difference in the incidence of complications between the two groups ( χ2 = 0.51, P > 0.05). Conclusion:Compared with small-incision rotator cuff repair, total arthroscopic rotator cuff repair has less invasive trauma and mild pain and is more conducive to postoperative shoulder function recovery.

Posterior shoulder fracture-dislocation: A systematic review of the literature and current aspects of management / 中华创伤杂志(英文版)

PURPOSE@#Posterior fracture-dislocation of shoulder is an infrequent traumatic event; however, most orthopaedic surgeons may face the challenge of treating it. The aim of this study is to review and summarise systematically the current principles of the management of this complex injury, and create a treatment algorithm.@*METHODS@#Both PubMed and Scopus Databases were systematically searched for the terms "posterior shoulder fracture-dislocation" or "posterior glenohumeral fracture-dislocation" or "posterior glenoid fracture-dislocation" for articles written in English and published in the last decade.@*RESULTS@#A total of 900 articles were identified, of which 13 were retained for analysis. A total of 153 patients (161 shoulders) were identified. These patients were treated either with open reduction and internal fixation, modified McLaughlin procedure, allograft/autograft humeral head reconstruction or shoulder arthroplasty. The mean age was 40.15 years. The mean postoperative Constant score in cases treated by open reduction and internal fixation was 86.45, whereas by bone graft was 84.18. Further, the mean postoperative Constant score was between 79.6 and 67.1 in those that were managed by modified McLaughlin and arthroplasty procedure, respectively.@*CONCLUSION@#The management of posterior shoulder fracture-dislocation may be challenging, and the best surgical option depends on many variables such as the chronicity of the injury, the presence of a fracture at the level of the surgical neck or tuberosities and the extend of the Hill-Sachs lesion if any. A treatment algorithm is proposed, based on the current literature in an effort to create a consensus for these injuries. For the acute shoulder fracture-dislocations, an open reduction should be performed. For the chronic fracture/dislocations in the elderly low-demand patients, conservative treatment should be performed. For the rest of the patients, depending on the severity of the Hill-Sachs lesion different surgical options are available such as the McLaughlin technique, the use of an allograft, osteotomy or arthroplasty.

Epidemiologic Study of Shoulder Injuries in the PyeongChang 2018 Winter Olympic Games

BACKGROUND: The purpose of this study is to describe and analyze the shoulder injuries in elite athletes during the 2018 Winter Olympics in Pyeongchang. METHODS: To collect the data of all Olympic athletes who visited venue medical centers, polyclinics, and Olympic-designated hospitals for shoulder injuries during the Olympic Games (February 9 through 25, 2018), we reviewed Olympic electronic medical records and patient information obtained from Olympic medical service teams about athletes who complained of shoulder pain. RESULTS: During the Olympics, a total of 14 athletes visited clinics for shoulder-related symptoms. Five athletes were injured in games and nine were injured in training. The injury was due to overuse in four patients. Ten patients had trauma-related symptoms: one after being hit by an opponent and the other nine after a collision with the ground or an object. There were no patients who complained of symptoms related to pre-existing shoulder conditions. The most common cause of shoulder pain was snow-boarding (one big air and three slopestyle). The most common diagnosis was contusion (n = 6), followed by rotator cuff injuries (n = 3), superior labrum from anterior to posterior lesion (n = 1), sprain (n = 1), acromioclavicular-coracoclavicular injury (n = 1), dislocation (n = 1), and fracture (n = 1). CONCLUSIONS: To the best of our knowledge, this study is the first epidemiologic study of shoulder injury conducted during a huge sports event involving a variety of competitions for elite athletes. If the risk factors of shoulder injury can be established by continuing research in the future, it will be helpful to prevent injury and to prepare safety measures for athletes.

The Size of the Rotator Cuff and the Positional Relationship of Bony Landmarks: An Anatomical Study / 체질인류학회지

For treatment of the rotator cuff, locating the structure and position of the rotator cuff is crucial. The aim of this study is to identify the size of each rotator cuff and the locational relationship with bony landmarks, and to provide superficial landmarks for locating the tendon from the surface. Fifty-two shoulders from 26 cadavers were dissected and measured in a supine position. The central point was set as the most protrusive point on the greater tubercle of the humerus. The measurement of angles was described ventral as positive (+) and dorsal as negative (-) placing the long axis of the humeral shaft at 0degrees. The range of the angle which each rotator cuff tendon is attached to the humerus head was: 53.8~103.3 degrees for the subscapularis, -17.1~25.7 degrees for the supraspinatus, -68.4~-1.9 degrees for the infraspinatus, and -117.1~-75.7 degrees for the teres minor. The vertical inferior point drawn from the anterior edge of the acromion to the humerus was 7.5+/-11.7 degrees from the central point. The average position of the point was the midpoint of insertion of the supraspinatus tendon. The lateral horizontal point drawn from the acromial angle to the humerus was -49.4+/-14.3 degrees away and located at an average of 30% inferior to the infraspinatus tendon. Also the lateral horizontal point drawn from the most protrusive point of the coracoid process to the humerus was 63.1+/-14.7 degrees away and located at an average of 20% superior to the subscapularis tendon. Lastly, the most protrusive point of the lesser tubercle of the humerus was located at a range of 80.8+/-11.1 degrees and an average of 60% superior to the insertion of the subscapularis tendon. For the measurements of the size of the rotator cuff, there was no statistical difference between the left and right. However, the four measurements - the proximal width of the teres minor tendon, the proximal and distal width, and the length of the subscapularis tendon - showed statistically significant difference between the sexes (P<0.05). Therefore, to identify the location of the tendon structures by palpation for shoulder treatment, using the lesser tubercle for the subscapularis, the anterior edge of the acromion for the supraspinatus, and the acromial angle for the infraspinatus as landmarks is regarded to be effective.

DEVELOPMENT OF THE PREDICTION SYSTEM FOR THE ONSET OF THROWING SHOULDER INJURY ∼WITH LOGISTIC REGRESSION ANALYSIS∼ / 体力科学

The purpose of this study is to identify the risk factors which affect the consecutive onset of throwing shoulder injury of a collegiate baseball team, and to calculate regression formula which could predict the future onset.Prospective study. The subjects are 69 asymptomatic collegiate baseball players. We executed medical checkups and investigated who got throwing shoulder injury during this year. We did logistic regression analysis with the medical checkup findings and the data of the onset and found out the factors which significantly affected the onset. We also calculated Odds ratio of these factors and regression formula which predict the probability of the onset of throwing shoulder injury and evaluated the validity of regression model.52%(36/69 cases) of the players suffered throwing shoulder injury during this year. Among the medical checkup findings of asymptomatic phase, pitcher and catcher, past history of throwing shoulder injury, abnormality of scapula-humeral rhythm, heel-buttock distance were thought to be the risk factors which were near-related to the onset of throwing shoulder injury. We calculated regression formula using the medical checkup findings of asymptomatic phase and we could predict the onset of throwing shoulder injury with 82.5% accuracy.In order to prevent this injury, the method used in this study could be useful for field players to predict the onset of throwing shoulder injury.

RELATIONSHIP BETWEEN MAJOR JOINT INJURY AND GENERAL JOINT LAXITY IN COLLEGIATE AMERICAN FOOTBALL PLAYERS / 体力科学

A preparticipation examination for athletes should be performed to prevent severe athletic injury by examining physical characteristics related to various injuries. The general joint laxity test has been included among the check-up items considering as relating factor of joint injury. Authors investigated the relationship between the score of general joint laxity for freshmen examination and the incidence of major joint injury, during the succeeding 5 athletic seasons, in eighty-seven collegiate American football players.<BR>Significant higher scores were observed in athletes affected by shoulder injury, and slightly higher scores in those affected by knee joint injury. But, the scores were similar between athletes with and without elbow or ankle injury.<BR>The degree of laxity was associated with shoulder and knee joint injury in a comparison of incidence of these injuries among tight, medium and lax groups.<BR>Authors concluded that general joint laxity is related to the incidence of shoulder and knee joint injury.