Effects of alternating heat and cold stimulation using a wearable thermo-device on subjective and objective shoulder stiffness

Background Technological innovations have allowed the use of miniature apparatus that can easily control and program heat and cold stimulations using Peltier elements. The wearable thermo-device has a potential to be applied to conventional contrast bath therapy. This study aimed to examine the effects of alternating heat and cold stimulation (HC) using a wearable thermo-device on subjective and objective improvement of shoulder stiffness. Methods Twenty healthy young male individuals (20.3 ± 0.6 years) participated in this study. The interventions were randomly conducted under four conditions, including HC, heat stimulation, cold stimulation, and no stimulation on their bilateral trapezius muscle, after a 30-min typing task. Each intervention was administered at least 1 week apart. The analyzed limb was the dominant arm. Muscle hardness was assessed using a portable muscle hardness meter, as well as the skin temperature over the stimulated area. After each condition, the participants were asked for feedback regarding subjective improvement in refreshed feelings, muscle stiffness, and muscle fatigue using an 11-point numerical rating scale. Results With regard to muscle hardness, only the HC condition significantly decreased from 1.43 N to 1.37 N (d = 0.44, p < 0.05). Additionally, reduced muscle hardness in HC condition was associated with the degree of skin cooling during the intervention (cold max: r = 0.634, p < 0.01; cold change: r = −0.548, p < 0.05). Subjective improvement in refreshed feelings, muscle stiffness, and muscle fatigue was determined in the HC and heat stimulation conditions compared with the no stimulation condition (p < 0.01 and p < 0.05, respectively). Moreover, the HC condition showed significantly greater improvements in muscle stiffness and fatigue compared to the cold stimulation condition (p < 0.05). Conclusions The current study demonstrated that HC promoted not only better subjective symptoms, such as muscle stiffness and fatigue, but also lesser muscle hardness. Furthermore, an association was observed between the degree of skin temperature cooling and reduced muscle hardness during HC. Further investigations on the ratio and intensity of cooling should be conducted in the future to establish the optimal HC protocol for muscle stiffness or fatigue. Trial registration UMIN000040620. Registered 1 June 2020

Functional Outcome of Proximal Humerus Fracture Managed Surgically by Joshi's External Stabilizing System

INTRODUCTION: The ideal management of proximal humerus fracture is still controversial despite various treatment options. Conservative treatment with slab is fraught with shoulder stiffness and malunion while surgical treatment with plates and nail is fraught with infection and blood loss. Therefore, Joshi External Stabilization System (JESS) being a minimally invasive percutaneous procedure can be the ideal treatment for these fractures. MATERIAL AND METHODS: This prospective and observational hospital based study was carried out in Orthopedics Department, Universal College of Medical Sciences Teaching Hospital (UCMS-TH) from December 2018 to January 2021. All patients with traumatic proximal humerus fracture who fulfilled the inclusion criteria were enrolled in the study and were treated with JESS. Fracture was classified according to Neer classification and functional outcome was assessed according to Constant Murley Score (CMS) system. Post-operatively patients were regularly followed at 6 weeks, 3 months and 6 months. RESULTS: There was statistically significant difference in VAS score (p<0.05) measured at six weeks, three months and six months; and CMS (p<0.05) at three months and six months. There was statistically significant difference between fracture type (Neer type) and fracture union (p<0.05). But the association between functional outcome and type of fracture was statically insignificant (p>0.05). CONCLUSION: Displaced proximal humerus fracture when treated surgically with JESS has good functional and radiological outcome. It produces less pain, less stiffness and greater Range of Motion (ROM).

Treatment of partial rotator cuff lesions is associated with a higher frequency of post-operative shoulder stiffness. A prospective investigation on the role of surgery-related risk factors for this complication

Purpose Post-operative shoulder stiffness (SS) is a common complication after arthroscopic rotator cuff (RC) repair. The aim of this prospective study is to evaluate the role of surgical risk factors in the development of this complication, with special focus on the characteristics of the RC tears. Methods Two-hundred and twenty patients who underwent arthroscopic RC repair for degenerative posterosuperior RC tears were included. Surgery-related risk factors for development of post-operative SS belonging to the following five categories were documented and analyzed: previous surgery, RC tear characteristics, hardware and repair type, concomitant procedures, time and duration of surgery. The incidence of post-operative SS was evaluated according to the criteria described by Brislin and colleagues. Results The incidence of post-operative SS was 8.64%. The treatment of partial lesions by tear completion and repair technique was significantly associated with development of post-operative SS (p = 0.0083, pc = 0.04). A multivariate analysis revealed that treatment of partial lesions in patients younger than 60 years was associated to a higher risk of developing post-operative SS (p = 0.007). Previously known pre-operative risk factors such as female sex and younger age were confirmed. No other significant associations were documented. Conclusion The treatment of partial lesions of the RC may lead to a higher risk of post-operative SS than the treatment of complete lesions, in particular in patients younger than 60 years. Possible explanations of this finding are the increased release of pro-inflammatory cytokines caused by the additional surgical trauma needed to complete the lesion and the different pain perception of the subgroup of patients who require surgical treatment already for partial tears. Evidence A higher risk of post-operative SS should be expected after tear completion and repair of partial lesions, especially in young patients. Appropriate pre-operative counseling and post-operative rehabilitation should be considered when approaching this subgroup of RC tears. Level of evidence Prognostic study, level II.

Mechanical Effects of Canes on Postural Control: Beyond Perceptual Information

BackgroundNumerous studies showed that postural balance improves through light touch on a stable surface highlighting the importance of haptic information, seemingly downplaying the mechanical contributions of the support. The present study examined the mechanical effects of canes for assisting balance in healthy individuals challenged by standing on a beam. MethodsSixteen participants supported themselves with two canes, one in each hand, and applied minimal, preferred, or maximum force onto the canes. They positioned the canes in the frontal plane or in a tripod configuration. ResultsResults showed that canes significantly reduced the variability of the center of pressure and center of mass to the same level as when standing on the ground. In the preferred condition, participants exploited the altered mechanics by resting their arms on the canes and, in the tripod configuration, allowing for larger CoP motions in the task-irrelevant dimension. Increasing the exerted force beyond the preferred level yielded no further benefits, in fact had a destabilizing effect on the canes: the displacement of the hand on the cane handle increased with the force. ConclusionsDespite the challenge of a statically unstable system, these results show that, in addition to augmenting perceptual information, using canes can provide mechanical benefits and challenges. First, the controller minimizes effort channeling noise in the task-irrelevant dimensions and, second, resting the arms on the canes but avoiding large forces that would have destabilizing effects. However, if maximal force is applied to the canes, the instability of the support needs to be counteracted, possibly by arm and shoulder stiffness.

Comparison of Gene Expression of Inflammation- and Fibrosis-Related Factors Between the Anterior and Posterior Capsule in Patients With Rotator Cuff Tear and Shoulder Stiffness

Background: Arthroscopic capsular release is an effective treatment for refractory shoulder stiffness, yet there are no basic studies that can explain the extent of the release. Purpose: This study aimed to compare the genetic expression of inflammation- and fibrosis-related factors between the anterior and posterior capsules in patients with shoulder stiffness and rotator cuff tear. Study Design: Descriptive laboratory study. Methods: Enrolled in this study were 35 patients who underwent arthroscopic capsular release for shoulder stiffness along with the rotator cuff repair. Anterior and posterior glenohumeral joint capsular tissues were obtained during the capsular release. For the control tissue, anterior capsule was obtained from 40 patients without stiffness who underwent arthroscopic rotator cuff repair. The gene expression of collagen types I and III, fibronectin, extracellular matrix, basic fibroblast growth factor, transforming growth factor–β, connective tissue growth factor, matrix metalloproteinase (MMP)-1, MMP-2, MMP-9, tissue inhibitor of metalloproteinase (TIMP)-1, TIMP-2, intercellular adhesion molecule 1, interleukin 1, and tumor necrotizing factor–α were analyzed using real-time reverse transcription polymerase chain reaction. Differences in gene expression between the anterior capsule, the posterior capsule, and the control tissue were compared with the Kruskal-Wallis test. Results: The expression levels of collagen types I and III were significantly higher in the anterior capsule with stiffness com (pared with both the posterior capsule with stiffness ( P = .010 for both) and the control ( P = .038 and .010, respectively). The levels of fibronectin, MMP-2, and MMP-9 in the anterior capsule were significantly higher than in both the posterior capsule ( P = .013, .003, and .006, respectively) and the control ( P = .014, .003, and .005, respectively). Conclusion: Genetic analysis of the shoulder capsule revealed that more fibrogenic processes occur in the anterior capsule compared with the posterior capsule in patients with shoulder stiffness. Clinical Relevance: Capsular release for shoulder stiffness should be more focused on the anterior capsule than on the posterior capsule.

Comprehensive rehabilitation of Supraspinatus tear: A case study of post-op fracture stiffness

The disorders of the upper extremity and the shoulder is extremely common accounting for 30 % of people who experience shoulder pain and stiffness at some stage of their ageing. A high incidence of shoulder dysfunction is seen in people in recent trends. Shoulder stiffness is the main complication after fracture shoulder immobilization, and Diabetes Mellitus contribute to the frozen shoulder, which is the most typical complication in Diabetes mellitus patients. A case of lateral clavicle fracture with chief complaints of pain on the right shoulder, stiffness around the joint and reduced range of motion was reported to the outpatient physiotherapy department for rehabilitation. A proper assessment was done, and the differential diagnosis was frozen shoulder with supraspinatus tendon tear was reported. The patient also had a reduced range of motion of shoulder abduction and lateral rotation due to frozen shoulder. The investigation of MRI report stated that there is a partial supraspinatus tendon tear. Medical examination of the frozen shoulder confirms the diagnosis. A combination of non-pharmacological treatment with exercises, NSAID and exercise therapy, was planned. He was successfully treated with the combination of physical therapy treatment with the electrotherapy modalities and shoulder girdle mobilization. Comprehensive therapeutic exercises include mobilization of soft tissue using Cyriax technique, peripheral joint mobilization to improve controlled ROM. Mobilization of soft tissue along with home exercise supports patients suffering from frozen shoulder. The treatment primarily aimed at relieving pain and increasing range of motion and thus improving the quality of life in the patient. Only manual therapy alone does not give satisfactory results along with electrotherapeutic modality with proper dose work on the patient.

1384Factors related to neck and shoulder pain during the COVID-19 pandemic in Japan

Background Shoulder stiffness is a common health issue in Japan. During the COVID-19 pandemic, people were forced to stay home which possibly escalated the development of shoulder stiffness. We aimed to assess associations of lifestyle changes and newly developed neck and shoulder pain (NSP) during the pandemic. Methods A cross-sectional study was conducted, analyzing the data from the Japan COVID-19 and Society Internet Survey (JACSIS), an internet survey conducted from August to September 2020. Data included sociodemographic, lifestyle and health measures related to NSP during the pandemic. Multivariable logistic regression models were fitted to calculate adjusted odds ratio (AOR) with 95% confidence interval (CI) for newly developed NSP with adjustment for lifestyle, physiological and psychosocial changes. Results After exclusion of participants with existing pain, 25,482 participants (12,673 male, 12,809 female) aged 15-79 years were included in the analysis. Of these, 4.1% reported newly developed NSP. Weight gain and long sedentary time were strongly associated with the NSP (AOR (95%CI): 2.4 (2.0-2.8) and 1.81 (1.4-2.3)). Stratified analyses of 1,751 students and 4,211 teleworkers showed significant associations (AOR (95%CI): 2.1 (1.4-2.8) and 2.5 (1.9-3.2)) compared to non-workers and non-teleworkers, respectively. Conclusions Students and teleworkers became prone to NSP during the pandemic. However, factors which were associated to pain did not differ during the pandemic compared with the previous studies. Key messages Preventive measures for NSP should be taken in students and teleworkers.

Choosing patient-reported outcome measures for shoulder pathology

This study was designed to identify the most frequent shoulder patient-reported outcome measures (PROMs) reported in high-quality literature. A systematic review was performed to identify shoulder PROMs, and their diffusion within the scientific literature was tested with a subsequent dedicated search in MEDLINE. 506 studies were included in the final data analysis, for a total number of 36,553 patients. The Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), the American Shoulder, Elbow Surgeons Score (ASES) and the Shoulder Pain and Disability Index (SPADI) were the most frequently reported PROMs in the analysed publications, with disease-specific PROMs being used with increasing frequency. A core set of outcome measures for future studies on patients with shoulder pathologies, based on the international acceptance and diffusion of each PROM, is needed. A combination of the DASH score for shoulder outcome assessment with more specific PROMs, such as the ASES for rotator cuff pathology and osteoarthritis and the SPADI for shoulder stiffness and shoulder pain of unspecified origin, is proposed as a recommended set of PROMs. Cite this article: EFORT Open Rev 2021;6:779-787. DOI: 10.1302/2058-5241.6.200109

Incidence and Risk Factors for Early Postoperative Stiffness after Arthroscopic Rotator Cuff Repair in Patients without Preoperative Stiffness

Purpose The purpose of this study was to investigate the incidence and risk factors of early postoperative stiffness in patients without preoperative stiffness undergoing isolated arthroscopic rotator cuff repair (ARCR). Methods Two hundred seventy-four patients who underwent primary ARCR were included. At 3 months after surgery, criteria for shoulder stiffness was set as follows: 1) passive forward flexion < 120˚, or 2) external rotation at side < 30˚. Patients with preoperative stiffness or who underwent additional procedures were excluded. Patients-related, radiological (muscle atrophy and fatty infiltration), and intraoperative (tear size, repair techniques, number of anchors used, and synovitis scores) risk factors were analyzed. Univariate and multivariate analyses were used to identify risk factors for postoperative stiffness. Results Thirty-nine of 274 patients (14.2%) who underwent ARCR developed postoperative stiffness. Univariate analyses revealed that early postoperative stiffness was significantly associated with diabetes mellitus (p = 0.030). However, radiological and intraoperative factors did not affect postoperative shoulder stiffness (all p > 0.05). Multivariate analyses revealed early postoperative stiffness was significantly associated with diabetes mellitus and timing of rehabilitation (p = 0.024, p = 0.033, respectively).Conclusion The overall incidence of early postoperative stiffness following isolated ARCR in patients without preoperative stiffness was 14.2%. Diabetes mellitus and timing of rehabilitation were independent risk factors for early postoperative stiffness following ARCR.