The reliability and effectiveness of shoulder joint evaluation by ultrasonography in stroke patients: deltoid muscle thickness, acromion-humeral distance, acromion-lesser tuberosity distance

Introduction: Quadriceps muscle atrophy and quality loss, defined as an increased ratio of intramuscular fat and/or connective tissue, are often observed especially in the paretic limb of post-stroke patients. This study was performed to examine the relationship of quadriceps muscle thickness (MT) with muscle echo intensity (EI) and the severity of motor paralysis after stroke. Methods: Thirty-six hemiparetic subacute post-stroke patients were enrolled. We examined the MT (index of muscle quantity) and the EI (index of muscle quality) at the anterior mid-thigh in both limbs. We also assessed the Brunnstrom stage (BR stage), subcutaneous adipose tissue thickness, time since stroke, age, body weight, sex, number of medications, and nutritional and inflammation status. Results: The MT in the paretic limb was explained by the BR stage (β = –0.26, p < 0.01), body weight (β = 0.68, p < 0.01), and serum albumin (β = 0.34, p < 0.01), with an adjusted R2 of 0.81. The MT in the non-paretic limb was explained by the muscle EI (β = –0.55, p < 0.01) and age (β = –0.40, p < 0.01), with an adjusted R2 of 0.69. The muscle EI was explained by the MT in the paretic limb (β = –0.34, p < 0.01) and non-paretic limb (β = –0.69, p < 0.01). Conclusions: Our results suggest that motor paralysis, aging, and malnutrition contribute to quadriceps atrophy in post-stroke patients. Moreover, a potential countermeasure to diminish muscle quality loss is maintenance of muscle quantity.

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Latissimus dorsi tendon transposition combined with shoulder joint proximal capsule plasty with peroneal longus tendon autograft in the treatment of patients with massive rotator cuff ruptures and proximal dislocation of the humerus head (clinical case)

Acta biomedica scientifica ◽

10.29413/abs.2021-6.5.17 ◽

2021 ◽

Vol 6 (5) ◽

pp. 178-183

Author(s):

D. V. Menshova ◽

N. S. Ponomarenko ◽

I. A. Kuklin

Keyword(s):

Rotator Cuff ◽

Humeral Head ◽

Shoulder Joint ◽

Latissimus Dorsi ◽

Clinical Case ◽

Deltoid Muscle ◽

X Rays ◽

Longus Tendon ◽

Surgical Methods ◽

The Right

The frequency of rotator cuff injuries in people over 45 years of age is 25.6–50 %, and 40 % of these injuries are massive. Shoulder rotator cuff injury causes disorders in biomechanics of the shoulder joint such as anterior-superior dislocation of the humeral head. Injury of the deltoid muscle combined with a massive rupture of the rotator cuff causes proximal dislocation of the humeral head during any active movement. In the treatment of these cases, surgical methods of treatment are used, such as transposition of the latissimus dorsi muscle, proximal capsule plasty, and reverse shoulder arthroplasty. We present a successful clinical case of treatment of a patient with chronic massive injury of the right shoulder joint rotator cuff tendons in combination with the injury of shoulder joint proximal capsule, dislocation of the right humerus head, and hypotrophy of the anterior portion of the deltoid muscle. We performed transposition of the latissimus dorsi tendon in combination with shoulder joint proximal capsule plasty with an autograft of the peroneal longus tendon. The check-up X-rays show that the dislocation of the right shoulder joint was eliminated. In the early postoperative period, the patient started physiotherapy exercises of the operated limb using abduction pillow. By the 7th day after surgery, the abduction of the operated limb reached 70°. The described surgical technique allows to restore congruence in the shoulder joint and the function of the injured limb in severe multiple injuries of the shoulder joint structures.

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Quantitative analysis of the distal, lateral, and posterior articular branches of the axillary nerve to the shoulder: implications for intervention

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2019-100560 ◽

2019 ◽

Vol 44 (9) ◽

pp. 875-880

Author(s):

Brittany Bickelhaupt ◽

Maxim S Eckmann ◽

Caroline Brennick ◽

Omid B Rahimi

Keyword(s):

Methylene Blue ◽

Shoulder Pain ◽

Nerve Block ◽

Humeral Head ◽

Shoulder Joint ◽

Deltoid Muscle ◽

Axillary Nerve ◽

Blue Staining ◽

Lateral Aspect ◽

Minor Muscle

IntroductionThe terminal sensory branches innervating the shoulder joint are potential therapeutic targets for the treatment of shoulder pain. This cadaveric study investigated in detail the anatomic pathway of the posterior terminal sensory branch of the axillary nerve (AN) and its relationship to nearby anatomic structures for applications, such as nerve block or ablation of the shoulder joint.MethodsFor this study, nine shoulders were dissected. Following dissection, methylene blue was used to stain the pathway of the terminal sensory branches of the AN to provide a visual relationship to the nearby bony structures. A transparent grid was overlaid on the humeral head to provide further detailed information regarding the innervation to the shoulder joint.ResultsEight of the nine shoulders displayed terminal sensory branches of the AN. The terminal sensory branches of the AN innervated the posterolateral head of the humerus and shoulder capsule and were deep and distal to the motor branches innervating the deltoid muscle and teres minor muscle. All terminal branches dissected innervated the shoulder capsule at the posteroinferior-lateral aspect of the greater tuberosity of the humerus. All specimens displayed innervation to the shoulder joint in the lateral most 25% and inferior most 37.5% before methylene blue staining.ConclusionThe terminal sensory branches of the AN consistently innervate the inferior and lateral aspects of the posterior humeral head and shoulder capsule. These nerves are easily accessible and would provide a practical target for nerve block or ablation to relieve shoulder pain without compromising motor integrity.

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Effect of trunk stabilization exercise on abdominal muscle thickness, balance and gait abilities of patients with hemiplegic stroke: A randomized controlled trial

Neurorehabilitation ◽

10.3233/nre-203133 ◽

2020 ◽

Vol 47 (4) ◽

pp. 435-442 ◽

Cited By ~ 1

Author(s):

Jiyeon Lee ◽

Jeongwoo Jeon ◽

Dongyeop Lee ◽

Jiheon Hong ◽

Jaeho Yu ◽

...

Keyword(s):

Outcome Measures ◽

Muscle Thickness ◽

Abdominal Muscle ◽

Secondary Outcome ◽

Control Group ◽

Abdominal Muscles ◽

Stroke Patients ◽

Trunk Stability ◽

Functional Reach Test ◽

Stability Training

BACKGROUND: Trunk stability has been identified as an important prerequisite of functional movement. OBJECTIVE: To investigate the effectiveness of core muscle contraction training on abdominal muscle thickness, balance, and gait ability in stroke patients. METHODS: Thirty patients with stroke were randomly assigned to two experimental groups and a control group. All groups received conventional therapeutic exercise program for six weeks. The experimental groups additionally trained trunk stability exercise with abdominal hollowing or bracing maneuvers within training time. Primary outcome measures were evaluated abdominal muscle thickness using the sonography. Secondary outcome measures were evaluated by the Functional Reach Test (FRT), Berg Balance Scale (BBS), 10-meter walk test (10MWT), and Timed Up and Go test (TUG). RESULTS: Compared with the control group, the effect of trunk stability training for the experimental groups on the abdominal muscles thickness change was observed (p < 0.05). The values in balance and gait measures, BBS, FRT, 10MWT, and TUG, showed significant improvement after the intervention periods (p < 0.05), although no significant differences were found in scores of gait and balance scales among groups. CONCLUSIONS: Trunk stability training with selective abdominal muscles activation has beneficial effects on abdominal muscles, balance, and mobility in stroke patients. Our findings might provide support for introducing stroke rehabilitation.

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