Arthroscopic shoulder suspensioplasty in painful hemiplegic shoulder subluxation-a case series.

Background: Inferior glenohumeral subluxation (GHS) can cause disabling pain in hemiplegics. Conservative treatments have not been proven to be effective or maintained over time. A few studies have shown the benefits of surgical treatment. The objective of our study was to evaluate the medium-term clinical and radiological results of arthroscopic glenohumeral suspensioplasty surgery by biceps tenodesis in the setting of painful GHS in hemiplegics. Methods: We conducted a retrospective study of patients who underwent arthroscopic glenohumeral suspensioplasty. The assessment, at a minimum of 1 year, included a clinical evaluation (pectoralis major spasticity, pain, range of motion, satisfaction) and a radiographic evaluation (Dursun classification, height of subacromial space). Results: Five patients with a mean age of 51 years (36-72 years) were included at a mean follow-up of 40 months (12-70). Satisfaction was good in 80% of patients. Pain decreased in all patients, but not significantly. Four patients (80%) would repeat the procedure if it were necessary. In all patients, a reduction in GHS over time was observed, with a reduction in subacromial height, except in 1 patient who suffered a tenodesis rupture during a fall. Conclusion: Our results suggest that arthroscopic glenohumeral suspensioplasty by biceps tenodesis may be a therapeutic option in hemiplegic patients with painful GHS.

Determining the True Incidence of Glenohumeral Instability Among Players in the National Football League: An Epidemiological Study of Non-Missed Time Shoulder Instability Injuries.

Background: Shoulder instability encompasses a spectrum of glenohumeral pathology ranging from subluxation to dislocation. While dislocation frequently leads to removal from play, athletes are often able to play through subluxation. Previous research on glenohumeral instability among athletes has largely focused on missed-time injuries, which has likely disproportionately excluded subluxation injuries and underestimated the overall incidence of shoulder instability. Purpose: To describe the epidemiology of shoulder instability injuries resulting in no missed time beyond the date of injury (non-missed time injuries) among athletes in the National Football League (NFL). Study Design: Descriptive epidemiology study. Methods: The NFL's electronic medical record was retrospectively reviewed to identify non-missed time shoulder instability injuries during the 2015 through 2019 seasons. For each injury, player age, player position, shoulder laterality, instability type, instability direction, injury timing, injury setting, and injury mechanism were recorded. For injuries that occurred during games, incidence rates were calculated based on time during the season as well as player position. The influence of player position on instability direction was also investigated. Results: Of the 546 shoulder instability injuries documented during the study period, 162 were non-missed time injuries. The majority of non-missed time injuries were subluxations (97.4%), occurred during games (70.7%), and resulted from a contact mechanism (91.2%). The overall incidence rate of game-related instability was 1.6 injuries per 100,000 player-plays and was highest during the postseason (3.5 per 100,000 player-plays). The greatest proportion of non-missed time injuries occurred in defensive secondary players (28.4%) and offensive linemen (19.8%), while kickers/punters and defensive secondary players had the highest game incidence rates (5.5 and 2.1 per 100,000 player-plays, respectively). In terms of direction, 54.3% of instability events were posterior, 31.9% anterior, 8.5% multidirectional, and 5.3% inferior. Instability events were most often anterior among linebackers and wide receivers (50% and 100%, respectively), while posterior instability was most common in defensive linemen (66.7%), defensive secondary players (58.6%), quarterbacks (100.0%), running backs (55.6%), and tight ends (75.0%). Conclusion: The majority of non-missed time shoulder instability injuries (97.4%) were subluxations, which were likely excluded from or underreported in previous shoulder instability studies due to the inherent difficulty of detecting and diagnosing shoulder subluxation.

A randomized crossover study of elbow-forearm support and traditional shoulder sling in the treatment of shoulder subluxation after stroke / 中华物理医学与康复杂志

Objective:To compare the immediate effectiveness of elbow forearm support with that of a traditional shoulder sling in reducing glenohumeral subluxation (GHS) after a stroke.Methods:Eight stroke survivors with GHS were randomized to receive either 30 minutes of intervention of an elbow forearm support treatment or a traditional shoulder sling treatment twice within 24 hours. Their healthy and affected shoulders were X-rayed before and right after the treatment is ongoing as well as after the end of the 30 min of treatment. The vertical (VD) and horizontal (HD) distances from the lower edge of the acromion to the center of the humeral head were measured. The satisfaction of the patients and their relatives was surveyed.Results:The average VD and HD improved significantly more after wearing the elbow forearm support. Moreover, the patients and their relatives expressed greater satisfaction with the elbow forearm support.Conclusion:Either an elbow forearm support or a traditional shoulder sling will have an immediate effect in reducing shoulder subluxation, but the elbow forearm support is more effective and gives greater satisfaction.

Elastic Dynamic Sling on Subluxation of Hemiplegic Shoulder in Patients with Subacute Stroke: A Multicenter Randomized Controlled Trial.

Background: Shoulder subluxation occurs in 17−64% of hemiplegic patients after stroke and develops mostly during the first three weeks of hemiplegia. A range of shoulder orthoses has been used in rehabilitation to prevent subluxation. However, there is little evidence of their efficacy. AIM: This study aimed to investigate whether there is a difference in the subluxation distance, pain, and functional level of the hemiplegic upper extremity among patients with two different shoulder orthoses. Design: This is a prospective, randomized controlled trial with intention-to-treat analysis. SETTING: Multicenter, rehabilitation medicine department of two university hospitals in South Korea. Population: Forty-one patients with subacute stroke with shoulder subluxation with greater than 0.5 finger width within 4 weeks of stroke were recruited between January 2016 and October 2021. Methods: The experimental group used an elastic dynamic sling while sitting and standing to support the affected arm for eight weeks. The control group used a Bobath sling while sitting and standing. The primary outcome was to assess the distance of the shoulder subluxation on radiography. The secondary outcomes were upper-extremity function, muscle power, activities of daily living, pain and spasticity. Result: The horizontal distance showed significant improvement in the elastic dynamic sling group, but there were no significant differences in the vertical distance between the elastic dynamic and Bobath sling groups. Both groups showed improvements in upper-extremity movements and independence in daily living after 4 and 8 weeks of using shoulder orthoses, and the differences within the groups were significant (p < 0.05). However, there were no significant differences in upper-extremity movements and independence in daily living between the two groups. Conclusions: The subluxation distance showed better results in the elastic dynamic sling, which has both proximal and distal parts, than in the Bobath sling, which holds only the proximal part. Both shoulder orthoses showed improvements in the modified Barthel index, upper-extremity function, and manual muscle testing.

A Combination of Long-Duration Electrical Stimulation with External Shoulder Support during Routine Daily Activities in Patients with Post-Hemiplegic Shoulder Subluxation: A Randomized Controlled Study.

The study objective was to determine the effect of long-duration neuromuscular electric stimulation (NMES) on shoulder subluxation and upper-extremity function during the acute post-stroke stage. Twenty-eight subjects (mean age ± standard deviation -70.0 ± 14.0 years) were randomly assigned to an experimental or to a control group receiving NMES to the supraspinatus and posterior deltoid muscles or sham treatment for 6 weeks. All the subjects continued standard rehabilitation and external shoulder support (EST). Assessments were conducted pre- and post-intervention and at a 2 week follow-up session by an assessor blind to group allocation. Outcome measures included the degree of shoulder subluxation, Fugl-Meyer assessment-upper extremity (FMA-UE) test, FMA-hand and finger subscales, Functional Independence Measure (FIM), and shoulder pain (using the Numeric Pain Rate Scale). Shoulder subluxation was significantly lower, while the FMA-UE and FMA-hand and finger subscales were significantly improved in the experimental group post-intervention and at follow-up compared to the control group. FIM at follow-up improved more in the experimental group. No change was observed in pain level in both groups. Supplementing NMES to standard rehabilitation and EST is beneficial in reducing shoulder subluxation and improving upper-extremity function. Further research is necessary to determine effect of longer treatment duration and longer follow-up periods.

Understanding Anterior Shoulder Instability Through Machine Learning: New Models That Predict Recurrence, Progression to Surgery, and Development of Arthritis.

BACKGROUND: Management of anterior shoulder instability (ASI) aims to reduce risk of future recurrence and prevent complications via nonoperative and surgical management. Machine learning may be able to reliably provide predictions to improve decision making for this condition. PURPOSE: To develop and internally validate a machine-learning model to predict the following outcomes after ASI: (1) recurrent instability, (2) progression to surgery, and (3) the development of symptomatic osteoarthritis (OA) over long-term follow-up. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: An established geographic database of >500,000 patients was used to identify 654 patients aged <40 years with an initial diagnosis of ASI between 1994 and 2016; the mean follow-up was 11.1 years. Medical records were reviewed to obtain patient information, and models were generated to predict the outcomes of interest. Five candidate algorithms were trained in the development of each of the models, as well as an additional ensemble of the algorithms. Performance of the algorithms was assessed using discrimination, calibration, and decision curve analysis. RESULTS: Of the 654 included patients, 443 (67.7%) experienced multiple instability events, 228 (34.9%) underwent surgery, and 39 (5.9%) developed symptomatic OA. The ensemble gradient-boosted machines achieved the best performances based on discrimination (via area under the receiver operating characteristic curve [AUC]: AUCrecurrence = 0.86), AUCsurgery = 0.76, AUCOA = 0.78), calibration, decision curve analysis, and Brier score (Brierrecurrence = 0.138, Briersurgery = 0.185, BrierOA = 0.05). For demonstration purposes, models were integrated into a single web-based open-access application able to provide predictions and explanations for practitioners and researchers. CONCLUSION: After identification of key features, including time from initial instability, age at initial instability, sports involvement, and radiographic findings, machine-learning models were developed that effectively and reliably predicted recurrent instability, progression to surgery, and the development of OA in patients with ASI. After careful external validation, these models can be incorporated into open-access digital applications to inform patients, clinicians, and researchers regarding quantifiable risks of relevant outcomes in the clinic.

Epidemiology of Shoulder Instability in the National Football League.

BACKGROUND: Shoulder instability is a common and potentially debilitating injury among collision sport athletes that can lead to long-term damage of the glenohumeral joint. Limited data exist regarding instability among elite athletes in the National Football League (NFL). PURPOSE: To describe the epidemiology of shoulder instability in the NFL from 2012 through 2017. STUDY DESIGN: Descriptive epidemiology study. METHODS: The NFL's injury database was reviewed for shoulder instability injuries resulting in missed time during the study inclusion dates. Injuries were classified by type and direction, as well as timing, setting, and mechanism. Median missed time was determined for the different types and directions of instability. Incidence rates for game-related injuries were calculated based on timing during the season and player position. Finally, the relationship between player position and instability direction was assessed. RESULTS: During the 6-year study period, 355 players sustained 403 missed-time shoulder instability injuries. Most injuries occurred during games (65%) via a contact mechanism (85%). The overall incidence rate of game-related instability was 3.6 injuries per 100,000 player-plays and was highest during the preseason (4.9 per 100,000 player-plays). The defensive secondary position accounted for the most injuries, but quarterbacks had the highest incidence rate in games (5.5 per 100,000 player-plays). Excluding unspecified events (n = 128; 32%), 70% (n = 192) of injuries were subluxations and 30% (n = 83) were dislocations; 75% of dislocations were anterior, while subluxations were more evenly distributed between the anterior and posterior directions (45% vs 52%, respectively). Players missed substantially more time after dislocation compared with subluxation (median, 47 days vs 13 days, respectively). When instability direction was known, the majority of instability events among quarterbacks and offensive linemen were posterior (73% and 53%, respectively), while anterior instability was most common for all other positions. CONCLUSION: Shoulder instability is a common injury in the NFL and can result in considerable missed time. Dislocations occur less frequently than subluxations but lead to greater time lost. While most dislocations are anterior, more than half of subluxations are posterior, which is likely the result of repetitive microtrauma to the posterior capsulolabral complex sustained during sport-specific motions such as blocking. The risk of instability varies by player position, and position may also influence instability direction.

Impact of shoulder subluxation on peripheral nerve conduction and function of hemiplegic upper extremity in stroke patients: A retrospective, matched-pair study.

Purpose: To investigate the impact of shoulder subluxation (SS) on peripheral nerve conduction and function of the hemiplegic upper extremity (HUE) in poststroke patients.Methods: Thirty post-stroke patients were selected (SS group: 15 patients, non-SS group: 15 patients, respectively). Evaluation of nerve conduction in upper limbs: the compound muscle action potential (CMAP) amplitude and latency of suprascapular, axillary, musculocutaneous, radial, median, and ulnar nerves; the motor and sensory conduction velocity and the sensory nerve action potential (SNAP) amplitude of median, ulnar, and radial nerves. The Brunnstrom stage scale was used to evaluate the HUE motor function.Results: Compared with the healthy side, the CMAP and SNAP amplitudes of tested nerves on the HUE in both groups were lower, and the CMAP latency of the suprascapular, axillary and musculocutaneous nerves on the HUE in the SS group was longer (P < 0.05). Compared with the HUE in non-SS group, the CMAP amplitude of tested nerves (except ulnar) was decreased more (P < 0.05), the motor conduction velocity of the median nerve was lower (P < 0.05), and the Brunnstrom stage of the HUE was lower in SS group (P < 0.05).Conclusions: Stroke may lead to extensive abnormal nerve conduction on the HUE, and SS may aggravate the abnormality, which may disturb the recovery of upper limb function.

Effect of kinesio taping on hemiplegic shoulder pain: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of kinesio taping for the management of hemiplegic shoulder pain. DATA SOURCES: MEDLINE, EMBASE, Web of Science, CENTRAL, CNKI, Wan Fang databases and the grey literature research were searched from inception to July 2020. METHODS: We considered randomized controlled trials in English or Chinese that used kinesio taping for the treatment of hemiplegic shoulder pain. Two reviewers independently screened the articles, scored the methodological quality using the PEDro scale, assessed risk of bias using the Cochrane's risk of bias tool and extracted the data. The outcomes included pain, motor function of the upper limb, magnitude of shoulder subluxation and activities of daily living post-intervention. RESULTS: A total of nine studies (n = 424) met the inclusion criteria. A meta-analysis demonstrated a significant effect of kinesio taping on pain (mean difference(MD)= -1.45, 95% confidence interval(CI): -1.98 to-0.92 cm, p < 0.0001), motor function of upper limb (MD = 4.22,95%CI: 3.49 to 4.95, p < 0.00001), magnitude of shoulder subluxation (standardized mean difference(SMD) = -0.65, 95%CI: -0.95 to -0.35, p < 0.0001) and activities of daily living (MD = 6.86, 95% CI: 3.99 to 9.73, p < 0.00001) post-intervention. CONCLUSION: This meta-analysis suggests a beneficial effect of kinesio taping for reducing shoulder subluxation, improving motor function of the upper limb and activities of daily living in patients with hemiplegic shoulder pain post-intervention, which could not be interpreted simply as a placebo effect. And it was associated with reduced pain for patients with chronic stroke.

Total shoulder arthroplasty with an anterior-offset humeral head in patients with a B2 glenoid.

BACKGROUND: To address severe posterior subluxation associated with the Walch B2 glenoid deformity, the eccentricity of the prosthetic humeral head can be reversed, allowing the humerus to remain in a relatively posterior position while the prosthetic humeral head remains well-centered on the glenoid. This study describes the short-term outcomes after anatomic total shoulder arthroplasty (TSA) using this technique. METHODS: We retrospectively reviewed a consecutive series of patients with a B2 glenoid who underwent TSA with the prosthetic eccentric humeral head rotated anteriorly for excessive posterior subluxation noted intraoperatively. Medical records were reviewed for visual analog scale (VAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Simple Shoulder Test (SST) scores. Final radiographs were analyzed for instability, lesser tuberosity osteotomy healing, and glenoid loosening. RESULTS: Twenty patients were included with outcome scores at a mean of 48 months. Mean VAS (P < .0001), ASES (P < .0001), and SST (P < .0001) scores improved significantly. Using the Lazarus classification for glenoid loosening, 5 patients had grade 1 lucency and 2 had grade 2 lucency at a mean of 24 months' follow-up. The remaining 13 patients had no glenoid lucencies. Radiographic decentering was reduced from a mean of 9.9% ± 5.7% preoperatively to 0.5% ± 3.0% postoperatively (P < .001). There were no cases of lesser tuberosity repair failures or revision surgery. CONCLUSION: TSA in patients with a B2 glenoid with a reversed, anterior-offset humeral head to address residual posterior subluxation resulted in excellent functional outcomes at short-term follow-up with improvement in humeral head centering. Early radiographic follow-up suggests low risks of progressive glenoid lucencies and component loosening.

Effects of Repetitive Peripheral Magnetic Stimulation on Shoulder Subluxations Caused by Stroke: A Preliminary Study.

OBJECTIVES: Shoulder subluxation is a common problem after stroke. It causes shoulder pain that affects activities of daily living. This study aimed to investigate the effect of repetitive peripheral magnetic stimulation on shoulder subluxation after stroke. METHODS: We enrolled 12 consecutive patients who, as a result of stroke, suffered shoulder subluxations, measuring at half of a fingerbreadth or more. All subjects underwent conventional rehabilitation, as well as repetitive peripheral magnetic stimulation of their supraspinatus, posterior deltoid, and infraspinatus muscles. We assessed the following parameters: shoulder subluxation, evaluated as the acromio-humeral interval using measurements taken from X-rays; shoulder pain, evaluated using the Numerical Rating Scale; the active range of motion of shoulder abduction; and the motor impairment of the upper extremities, evaluated using the upper extremity of the Fugl-Meyer Assessment scale. RESULTS: The acromio-humeral interval before treatment was 22.8 ± 5.7 mm (mean ± SD). It significantly decreased to 19.6 ± 7.0 mm (p = 0.004) after treatment. Shoulder pain (p = 0.039), active range of motion of shoulder abduction (p = 0.016), and total (p = 0.005), subscale A (p = 0.005), and subscale C (p = 0.008) Fugl-Meyer Assessment scores also improved significantly after treatment. CONCLUSIONS: Repetitive peripheral magnetic stimulation effectively reduced shoulder subluxations and shoulder pain caused by stroke and improved voluntary upper-limb movements in stroke patients.

Shoulder pain after recent stroke (SPARS): hemiplegic shoulder pain incidence within 72hours post-stroke and 8-10 week follow-up (NCT 02574000).

OBJECTIVES: This study aimed to identify very early incidence of hemiplegic shoulder pain within 72hours (HSP), how clinical assessment was related to pain at 8-10 week follow-up and explore current standard therapy/management. DESIGN: Observational, prospective. SETTING: Teaching hospital hyper-acute and follow-up stroke services. PARTICIPANTS: 121 consecutive patients with confirmed cerebral infarct/haemorrhage recruited within 72hours of stroke onset. INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: Subjective report of pain severity and aggravating factors: using numerical rating scales and pain questionnaire (ShoulderQ), shoulder abductor and flexor muscle strength (Oxford MRC Scale), Neer's Test of sub-acromial pain, shoulder subluxation and soft tissue shoulder palpation. RESULTS: At initial assessment (<72hours), 35% (42/121) reported HSP. At follow-up (8-10 weeks), 44% (53/121) had pain: pain persisted in 32 of the original 42, resolved in 10 and had developed since initial assessment in 21. Pain at follow-up was associated with a statistically significant higher frequency of severe shoulder muscle weakness (MRC grade ≤2) and gleno-humeral subluxation at initial assessment. Soft tissue palpation and Neer's Test detected pain but did not predict development of HSP. 50/121 patients had 140 therapy interventions, particularly targeted to those with a higher HSP risk. CONCLUSION: This study reports HSP at an earlier time point after stroke than previous publications. Patients with severe arm weakness and/or shoulder subluxation within 72hours are at significantly higher risk of HSP at 8-10 weeks. These data highlight the high incidence of HSP, the non-standardized therapy approach, and can inform sample size calculations for future intervention studies. CLINICAL TRIAL REGISTRATION: NCT02574000 (clinicaltrials.gov).

Return to play and performance after shoulder instability in National Basketball Association athletes.

HYPOTHESIS: We hypothesized that players in the National Basketball Association (NBA) who sustained a shoulder destabilizing injury could return to play (RTP) successfully at a high rate regardless of treatment type. METHODS: We used publicly available data to identify and evaluate 50 players who sustained an in-season shoulder instability event (subluxation/dislocation) while playing in the NBA. Demographic variables, return to NBA gameplay, incidence of surgery, time to RTP, recurrent instability events, and player efficiency rating (PER) were collected. Overall RTP was determined, and players were compared by type of injury and mode of treatment. RESULTS: All players (50/50) returned to game play after sustaining a shoulder instability event. In those treated nonoperatively, athletes who sustained shoulder subluxations returned after an average of 3.6 weeks, compared with 7.6 weeks in those who sustained a shoulder dislocation (P = .037). Players who underwent operative management returned after an average of 19 weeks. Athletes treated operatively were found to have a longer time interval between a recurrent instability event (70 weeks vs. 28.5 weeks, P = .001). CONCLUSION: We found 100% rate of RTP after a shoulder instability event in an NBA athlete. Players who experience shoulder dislocations were found to miss more time before RTP and were more likely to undergo surgical intervention compared with those who experienced a subluxation. Surgical repair maintained a longer interval between recurrent instability. Future investigations should aim to evaluate outcomes based on surgical procedures and identify possible risk factors predictive of recurrent instability or failure to RTP.

Shoulder Subluxation Pain as a Secondary Indication for Trapezius to Deltoid Transfer.

Brachial plexus injuries can be debilitating. We have observed that manual reduction of the patients' shoulder subluxation improves their pain and have used this as a second reason to perform the trapezius to deltoid muscle transfer beyond motion. The authors report a series of nine patients who all had significant improvement of pain in the shoulder girdle and a decrease in pain medication use after a trapezius to deltoid muscle transfer. All patients were satisfied with the outcomes and stated that they would undergo the procedure again if offered the option. The rate of major complications was low. The aim is not to describe a new technique, but to elevate a secondary indication to a primary for the trapezius to deltoid transfer beyond improving shoulder function: pain relief from chronic shoulder subluxation.

Return to play after shoulder instability in National Football League athletes.

HYPOTHESIS: We hypothesized that National Football League (NFL) players sustaining a shoulder destabilizing injury could return to play (RTP) successfully at a high rate regardless of treatment type. METHODS: We identified and evaluated 83 NFL players who sustained an in-season shoulder instability event while playing in the NFL. NFL RTP, incidence of surgery, time to RTP, recurrent instability events, seasons/games played after the injury, and demographic data were collected. Overall RTP was determined, and players who did and did not undergo operative repair were compared. RESULTS: Ninety-two percent of NFL players returned to NFL regular season play at a median of 0.0 weeks in those sustaining a shoulder subluxation and 3.0 weeks in those sustaining a dislocation who did not undergo surgical repair (P = .029). Players who underwent operative repair returned to play at a median of 39.3 weeks. Forty-seven percent of players had a recurrent instability event. For players who were able to RTP, those who underwent surgical repair (31%) had a lower recurrence rate (26% vs. 55%, P = .021) and longer interval between a recurrent instability event after RTP (14.7 vs. 2.5 weeks, P = .050). CONCLUSION: There is a high rate of RTP after shoulder instability events in NFL players. Players who sustain shoulder subluxations RTP faster but are more likely to experience recurrent instability than those with shoulder dislocations. Surgical stabilization of the shoulder after an instability event decreases the chances of a second instability event and affords a player a greater interval between the initial injury and a recurrent event.

Effect of Athletic Taping on Subluxation of Shoulder after Stroke / 中国康复理论与实践

@#Objective To observe the effect of athletic taping on shoulder subluxation in stroke patients with hemiplegia. Methods From March, 2017 to March, 2018, 40 stroke patients with hemiplegia were randomly divided into control group (n = 20) and experiment group (n = 20). They all accepted routine rehabilitation training, and the experiment group accepted athletic taping before the training. They were measured acromio-humeral distance (AHD) before and after four weeks of treatment. Meanwhile, the were assessed with Visual Analogue Scale (VAS) of pain, simplified Fugl-Meyer Assessment-upper extremity (FMA-UE) and Functional Comprehensive Assessment (FCA). Results AHD, and scores of VAS, FMA-UE and FCA improved in both the groups after treatment (Z > 3.508, t > 4.544, P < 0.001), and improved more in the scores of VAS, FMA-UE and FCA in the experiment group than in the control group (Z = -3.151, t > 2.843, P < 0.01). Conclusion Athletic taping can alleviate shoulder pain, promote upper limb functional recovery and improve the ability of daily living for stroke patients with hemiplegia.

Sonographic detection of inferior subluxation in post-stroke hemiplegic shoulders.

AIM OF THE STUDY: To evaluate the usefulness of ultrasonographic acromion-greater tuberosity distance measurement and Shoulder ratio in detecting post-stroke inferior shoulder subluxation. MATERIAL AND METHODS: Forty-five hemiplegic stroke patients and 45 controls underwent shoulder sonography to measure their acromion-greater tuberosity distance. Side-to-side acromion-greater tuberosity distance differences and Shoulder ratios were derived from the acromion-greater tuberosity distance values. The long head of biceps tendon, subscapularis tendon, supraspinatus tendon, and the infraspinatus tendon were also evaluated to exclude full thickness tendon tears. Data were analyzed using the Statistical Package for Social Sciences version 20.0 for windows. Normality of data distribution was checked using the Kolmogorov-Smirnov test. Mann-Whitney U test and Chi-square tests were utilized. RESULTS: Hemiplegic and control shoulders' acromion-greater tuberosity distance values were 2.8 ± 0.6 cm and 2.4 ± 0.4 cm, respectively (p = 0.001). Hemiplegic and control shoulder ratios were 1.3 ± 0.3 and 1.1 ± 0.1, respectively; p < 0.001. Point biserial correlation showed that the presence of subluxation correlated moderately with higher shoulder ratios in all the hemiplegics (rpb = 0.520; p < 0.001). CONCLUSION: Our results suggest that acromion-greater tuberosity distance measurement is useful for detecting inferior shoulder subluxation. Shoulder ratio may be of complementary or supplemental value to acromion-greater tuberosity distance difference.

Functional validation reveals the novel missense V419L variant in TGFBR2 associated with Loeys-Dietz syndrome (LDS) impairs canonical TGF-ß signaling.

TGF-ß-related heritable connective tissue disorders are characterized by a similar pattern of cardiovascular defects, including aortic root dilatation, mitral valve prolapse, vascular aneurysms, and vascular dissections and exhibit incomplete penetrance and variable expressivity. Because of the phenotypic overlap of these disorders, panel-based genetic testing is frequently used to confirm the clinical findings. Unfortunately in many cases, variants of uncertain significance (VUSs) obscure the genetic diagnosis until more information becomes available. Here, we describe and characterize the functional impact of a novel VUS in the TGFBR2 kinase domain (c.1255G>T; p.Val419Leu), in a patient with the clinical diagnosis of Marfan syndrome spectrum. We assessed the structural and functional consequence of this VUS using molecular modeling, molecular dynamic simulations, and in vitro cell-based assays. A high-quality homology-based model of TGFBR2 was generated and computational mutagenesis followed by refinement and molecular dynamics simulations were used to assess structural and dynamic changes. Relative to wild type, the V419L induced conformational and dynamic changes that may affect ATP binding, increasing the likelihood of adopting an inactive state, and, we hypothesize, alter canonical signaling. Experimentally, we tested this by measuring the canonical TGF-ß signaling pathway activation at two points; V419L significantly delayed SMAD2 phosphorylation by western blot and significantly decreased TGF-ß-induced gene transcription by reporter assays consistent with known pathogenic variants in this gene. Thus, our results establish that the V419L variant leads to aberrant TGF-ß signaling and confirm the diagnosis of Loeys-Dietz syndrome in this patient.

Effectiveness of neuromuscular electrical stimulation for management of shoulder subluxation post-stroke: a systematic review with meta-analysis.

OBJECTIVES: To examine the effectiveness of neuromuscular electrical stimulation (NMES) for the management of shoulder subluxation after stroke including assessment of short (1 hour or less) and long (more than one hour) daily treatment duration. DATA SOURCES: MEDLINE, CENTRAL, CINAHL, WOS, KoreaMed, RISS and reference lists from inception to January 2017 Review methods: We considered randomized controlled trials that reported neuromuscular electrical stimulation for the treatment of shoulder subluxation post-stroke. Two reviewers independently selected trials for inclusion, assessed trial quality, and extracted data. RESULTS: Eleven studies were included (432 participants); seven studies were good quality, four were fair. There was a significant treatment effect of neuromuscular electrical stimulation for reduction of subluxation for persons with acute and subacute stroke (SMD:-1.11; 95% CI:-1.53, -0.68) with either short (SMD:-0.91; 95% CI:-1.43, -0.40) or long (SMD:-1.49; 95% CI:-2.31, -0.67) daily treatment duration. The effect for patients with chronic stroke was not significant (SMD:-1.25; 95% CI:-2.60, 0.11). There was no significant effect of neuromuscular electrical stimulation on arm function or shoulder pain. CONCLUSION: This meta-analysis suggests a beneficial effect of neuromuscular electrical stimulation, with either short or long daily treatment duration, for reducing shoulder subluxation in persons with acute and subacute stroke. No significant benefits were observed for persons with chronic stroke or for improving arm function or reducing shoulder pain.

Hill-Sachs lesion classification under arthroscopic findings.

BACKGROUND: The Hill-Sachs lesion (HSL) plays a role in recurrent glenohumeral joint instability. Currently, there are no studies based on the form characteristics of HSL. The purposes of this study were to report the HSL form characteristics and to determine whether they are correlated with number of prior subluxations and dislocations. METHODS: The study enrolled 134 consecutive patients diagnosed with anterior shoulder instability during an arthroscopic procedure. We classified the arthroscopic findings into 4 types, as follows: type 1, cyst type; type 2, gutter type; type 3, island type; and type 4, wide type. Subsequently, we investigated the correlation between each type and the number of shoulder subluxations and dislocations reported. The following data were analyzed: subluxation and dislocation history, arthroscopic findings, and maximum lesion size. RESULTS: Of the patients evaluated, 18, 32, 30, and 54 were classified as types 1 to 4, respectively. The mean numbers of shoulder dislocations were 3.3, 7.3, 6.0, and 12.0 for types 1 to 4, respectively. The wide type was correlated with more subluxations and dislocations than the other types (P = .001, .046, and .007, respectively). There were significant differences in mean width among all types (P < .0001). HSL width was correlated with lesion type and angle. CONCLUSION: We classified HSL into 4 types on the basis of visual inspection and found a correlation between lesion type and lesion size. However, HSL width was correlated with lesion type and angle; that is, the number of dislocations and subluxations does not affect HSL width.