Is shoulder joint position sense affected in partial and full-thickness supraspinatus tears?

PURPOSE: Neuromuscular control is important for joint stabilization. Supraspinatus muscle plays an essential role in the perception of proprioceptive sense. The aim of this study is to investigate active joint position sense (AJPS) both in patients with partial and full-thickness supraspinatus tears and in healthy participants. METHODS: Twenty patients with partial supraspinatus tears, 20 patients with full-thickness supraspinatus tears, and 20 healthy participants, aged 40-65 years, were included in the study. Proprioceptive sense was assessed with AJPS measurement. Absolute error was calculated to evaluate joint position sense. RESULTS: Active joint position sense was decreased in partial and full-thickness tears on both in affected and contralateral shoulders compared to control group (p < 0.05). There was no difference between groups with partial and full-thickness tears on the affected and contralateral shoulders at 40° and 100° elevation (p > 0.05). CONCLUSION: AJPS was affected after supraspinatus injury. It was seen as proprioceptive deficit in patients with partial and full-thickness tears in both affected and contralateral shoulders.

Does Upper Extremity Proprioceptive Training Have an Impact on Functional Outcomes in Chronic Stroke Patients?

OBJECTIVE: We aimed to investigate the effect of upper extremity proprioceptive training on spasticity and functional motor skills in patients with chronic hemiplegia occurring after stroke. METHOD: Thirty chronic hemiplegic patients (17 females, mean age: 66.47±12.55 years) admitted to the Research Center with a diagnosis of chronic hemiplegia developed after stroke were included in the study. Patients were divided into two groups. The first group received a conventional physiotherapy program (PTR) for 5 days a week and the second group additionally received a proprioceptive training program (PTR-PT) for 5 days a week. Before and 6 weeks after the treatment modified Ashworth scale (MAS), Fugl-Meyer upper extremity motor evaluation scale (FMA) and action-research-arm-test (ARAT) and motor activity log-28 scale (MAL-28) were applied. SSPS-22.0 program was used for statistical evaluation and p <0.05 was considered as the level of statistical significance. RESULTS: There was no difference in MAS scores before and after treatment in the groups (p>0.05). There was a statistically significant improvement in both PTR (p<0.05) and PTR-PT groups (p<0.001) for the FMA, ARAT and MAL-28. scale scores. Although the results obtained in the PTR, and PT groups were more improved, there was a significant result in favor of PTR-PT only regarding the MAL-28 scale scores (p<0.05). It was determined that adding proprioception-based exercises had the greatest effect on FMA, ARAT and MAL-28 in the evaluation of the effect size (>0.3). CONCLUSION: It was observed that upper extremity proprioceptive training yielded better results in patients with chronic hemiplegia developed after stroke than conventional therapy in increasing the frequency and quality of movement in upper extremity. This result shows that proprioceptive training programs should be added to stroke rehabilitation methods.

Can we use the contralateral glenoid cavity as a reference for the measurement of glenoid cavity bone loss in anterior shoulder instability?: a comparative analysis of 3D CT measurements in healthy subjects / ¿Podemos utilizar la cavidad glenoidea contralateral como referencia para la medición de la pérdida ósea de la cavidad glenoidea en la inestabilidad del hombro anterior?: un análisis comparativo de mediciones 3D TC en sujetos sanos

The purpose of this study was to compare the glenoid cavity measurements in healthy subjects. 100 adult subjects without shoulder pathology who had pulmonary computed tomography for any reason, were included in the study. Lung CT images were three-dimensionally rendered and glenoid cavity enface images were obtained. On these images, the glenoid cavity superior-inferior long axis and anterior-posterior equator, as well as the equatorial anterior and posterior radii, were measured. Dominant and nondominant glenoid cavity measurements were compared using the t-test in dependent groups. The long axis of the dominant glenoid cavity was 38.15 ± 3.5 mm, whereas it was 37.87 ± 3.3 mm on the non-dominant side (p = 0.068). The mean width of the glenoid cavity was 28.60 ± 3.3 mm in dominant glenoids cavities and 28.00 ± 2.9 mm in the non-dominant side (p = 0.0001). The equatorial anterior and posterior radii were significantly different between the two sides (p = 0.010, p = 0.001, respectively). The ratio of length to equator was different between the two sides (p = 0.012). The difference in equatorial lengths was 0.98 ± 0.8 mm (range, 0-4.2 mm). The mean difference between the long axis of the glenoid cavity was 1.2 ± 0.9 mm (range 0-4.6 mm). The equator on 69 individuals was larger on the dominant side. Glenoid cavity long axis was larger on the dominant side of 61 individuals. Glenoids cavities are not equal and not symmetrical to each other or influenced by hand dominancy. Measurements based on the assumption that both glenoids cavities are equal may be misleading.

El propósito de este estudio fue comparar las mediciones de las cavidades glenoideas en sujetos sanos. Se incluyeron en el estudio 100 sujetos adultos sin patología de hombro que tenían tomografía computarizada pulmonar. Las imágenes de CT de pulmón se representaron tridimensionalmente y se obtuvieron imágenes de la faceta de la cavidad glenoidea. En estas imágenes, se midieron el eje largo glenoideo superior e inferior y el ecuador anteroposterior, así como los radios ecuatoriales anterior y posterior. Las mediciones de las cavidades glenoideas dominantes y no dominantes se compararon usando la prueba t en grupos dependientes. El eje largo de la cavidad glenoidea dominante fue 38,15 ± 3,5 mm, mientras que fue 37,87 ± 3,3 mm en el lado no dominante (p = 0,068). El ancho medio de la cavidad glenoidea fue de 28,60 ± 3,3 mm en las glenoides dominantes y de 28,00 ± 2,9 mm en el lado no dominante (p=0,0001). Los radios ecuatoriales anterior y posterior fueron significativamente diferentes entre los dos lados (p=0,010; p=0,001, respectivamente). La relación de longitud al ecuador fue diferente entre los dos lados (p=0,012). La diferencia en las longitudes ecuatoriales fue de 0,98 ± 0,8 mm (rango, 0-4,2 mm). La diferencia media entre el eje largo de la cavidad glenoidea fue de 1,2 ± 0,9 mm (rango 0-4,6 mm). El ecuador en 69 individuos era más grande en el lado dominante. En 61 individuos el eje largo de cavidad glenoidea fue más grande en el lado dominante. Las cavidad glenoideas no son iguales ni simétricas entre sí ni están influenciadas por la dominancia de la mano. Las mediciones basadas en la suposición de que ambas cavidades glenoideas son iguales pueden ser engañosas.

Effects of montelukast sodium on tendon healing: An experimental study.

INTRODUCTION: Montelukast sodium (MS) a selective leukotriene antagonist of the cysteinyl leukotriene receptor, has been used in the treatment of asthma and allergic rhinitis. In this study, we evaluated the effect of MS on the early inflammatory phase (histological) of nonsynovial tendon healing. MATERIALS AND METHODS: Rats were divided randomly into two groups (n = 6 each). MS (Singulair) was administered to one group at 10 mg/kg/day [250 g/day intraperitoneally (i.p.)]. The control group was administered 250 g/day of 0.9% saline i.p. This nonsynovial tendon was longitudinally divided at the midportion, cut transversely and then sutured. In both groups, the rats were sacrificed by decapitation 10 days later. RESULTS: Decreased inflammatory cell infiltration and more properly oriented collagen fibres were observed in the MS group's histopathological specimens as compared to the control group's (P < 0.05). Additionally, vascularity was decreased in the MS group. CONCLUSION: MS decreased tendon healing, apparently by inhibiting the early inflammatory phase of nonsynovial tendon healing.

Relationship between the functional outcomes and radiological results of conservatively treated displaced proximal humerus fractures in the elderly: A prospective study.

PURPOSE: The purpose of this prospective study is to investigate the relationship between the functional outcome and the radiographic results of conservatively treated two-, three- and four-part proximal humeral fractures in patients aged over 65 years. MATERIALS AND METHODS: The study comprised 29 prospectively followed cases aged over 65 years who presented with displaced proximal humerus fracture between 2009 and 2011. The fractures were classified according to the Neer classification and all met the displacement criteria described by Neer. Standard physical therapy program was applied. Patients were evaluated clinically using Constant shoulder score, quick form of disabilities of arm, shoulder and hand score and visual analog scale. At the final follow-up, humeral head position in the coronal plane was assessed with neck-shaft angle. Any complication was recorded during the treatment period. Correlation between the functional outcomes and final radiologic results were statistically analyzed. RESULTS: Data were analyzed from 29 cases (21 female, 8 male) with a mean age was 78 ± 8.6 years (range 65-93 years). The mean follow-up period was 18.2 ± 4.07 months (range 12-26 months). Functional results were significantly related with initial fragmentation. However, there was no correlation between the functional outcomes and the final geometry of the humeral head. Despite the union occurred with deformity, the functional outcome were satisfactory. CONCLUSION: The results of this study show that initial fragmentation has a negative effect on the functional results. However, the changed position of the humeral head on coronal plane does not affect the final functional results.

Results of arthroscopic repair of partial- or full-thickness longitudinal medial meniscal tears by single or double vertical sutures using the inside-out technique.

BACKGROUND: Although numerous studies have assessed arthroscopic repair of meniscal tears, no study has described the repair of partial- or full-thickness longitudinal medial meniscal tears using single or double vertical sutures. PURPOSE: To present the intermediate-term results of medial meniscal tears repaired with single or double vertical sutures. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The authors evaluated the results of 112 longitudinal medial meniscal tears treated with inside-out single or double vertical sutures, with or without anterior cruciate ligament (ACL) reconstruction, based on the clinical resolution of symptoms, the Lysholm knee scoring scale, and the Tegner activity scale. Re-examination was also performed by magnetic resonance imaging after the repair. The length of the tears was evaluated arthroscopically. Eighty-five tears of 112 were >2 cm in length, and 27 were tears ≤2 cm. Eighty-nine (79.4%) of the 112 repairs were performed in conjunction with ACL reconstructions, and the remaining 23 (20.6%) repairs were performed in ACL-intact knees. The tear type of the menisci in our study was full thickness in 66 (58.9%) cases and partial thickness in 46 (41.1%) cases. Double vertical sutures were used for full-thickness tears, and single vertical sutures were used for partial-thickness tears. RESULTS: The cases were evaluated after a mean follow-up duration of 49.3 months (range, 12-88 months). Clinical and radiological examination results determined that 99 (88.4%) meniscal repairs had healed, and the remaining 13 cases (10.6%) were considered to be failures. The healing rate of the full-thickness group was 80.3%, while in the partial-thickness group, the rate was 100%. The mean Lysholm score improved significantly from a preoperative value of 63.8 to a postoperative value of 89.5 (P < .001). The mean Tegner activity score was 3.3 preoperatively and 6.7 postoperatively (P < .001). Logistic regression analysis found that concurrent ACL reconstruction, tear length, and smoking as factors had a significant effect on meniscal healing. CONCLUSION: Single or double vertical sutures using the inside-out technique provide a high rate of healing in longitudinal medial meniscal tears.

Carotid sinus hypersensitivity due to shoulder sling pressure after arthroscopic rotator cuff repair: a case report.

The beach chair position is one of the most commonly used positions in arthroscopic shoulder surgery because of its anatomical nature and easy modifiability to open surgery. Despite these advantages, thromboembolic and neurologic complications have been reported. We report a case of carotid sinus hypersensitivity due to shoulder sling pressure after arthroscopic shoulder surgery.