Effect of subacromial erosion shape on rotator cuff and clinical outcomes after hook plate fixation in type 5 acromioclavicular joint dislocations: a retrospective cohort study

Background Surgical fixation using hook plates is widely used in the treatment of acromioclavicular (AC) joint dislocations. The purpose of this study was to evaluate the incidence and shape of subacromial erosions after removal of the hook plate in type 5 AC joint dislocations. Further, we evaluated the effect of the shape of the subacromial erosion on the rotator cuff. Methods We retrospectively reviewed 30 patients who underwent hook plate fixation for type 5 AC joint dislocations at our hospital between December 2010 and December 2018. Patients with a follow-up of at least 1 year were included. Clinical outcomes were assessed using the final follow-up Constant-Murley, Korean Shoulder, and visual analog scores. To ensure that the appropriate reduction was well maintained, the coracoclavicular distances of the injured and contralateral sides were evaluated at the last follow-up. Computed tomography was performed to investigate the presence and shape of the subacromial erosion after hook plate removal at 4 months after surgery. Ultrasonography was performed to investigate the presence of rotator cuff lesions at the last follow-up. Clinical and radiological outcomes were compared between groups divided according to the presence and types of subacromial erosions. Results Subacromial erosion was observed in 60% of patients (18/30): 13, 2, and 3 simple groove, cave, and marginal protrusion types, respectively. Four patients showed reduction loss at the final follow-up. There were no significant differences in clinical and radiological outcomes between the groups with and without subacromial erosion. Moreover, there were no significant differences between groups according to the types of subacromial erosion. There were no rotator cuff lesions, such as partial tears, in the injured shoulders. Conclusions Hook plate fixation may induce subacromial erosions. However, the subacromial erosions caused by the hook plate did not affect the clinical outcomes of type 5 AC joint dislocations. Moreover, regardless of its shape, the subacromial erosion did not affect the clinical outcomes nor cause rotator cuff lesions after plate removal.

Ultrasound-Guided Treatments for the Painful Shoulder

: Shoulder pain is an extremely common condition. The painful shoulder may be the result of a wide spectrum of underlying pathological conditions, including calcific tendinopathy of the rotator cuff, subacromial-subdeltoid bursitis, acromioclavicular or glenohumeral arthritis, tenosynovitis of the long biceps tendon, rotator cuff lesions, and many other less common conditions. Ultrasound imaging is an effective tool for the diagnosis and also for the image guidance of treatment of the majority of these conditions. Several ultrasound-guided procedures are effective for pain relief, such as percutaneous irrigation, intra-bursal or intra-articular drugs injection, fluid aspiration, neural block. This review article aims to summarize and discuss the most common treatment possibilities with ultrasound guidance for the painful shoulder.

Shoulder Involvement in Daily Practice – Ultrasonographic Approach

Shoulder involvement is one of the most frequent findings in rheumatology and many of the rheumatic diseases can determine inflammatory lesions, as well as degenerative ones. Due to the non-specificity of clinical symptoms, imaging methods are emerging into the daily practice in order to establish an accurate diagnosis. Objectives. The aim of the study was to determine the presence of different pathologic changes in patients with shoulder pain, depending on the concurrent disease and associated risk factors. Material and methods. We included in our retrospective study 40 consecutive patients that presented with shoulder pain, during the past 6 months, in the Department of Rheumatology. All those patients underwent ultrasound evaluation according to EULAR Guidelines for musculoskeletal Ultrasound in Rheumatology. Results. Rotator cuff lesions, which most commonly underlie non traumatic pain in adults, were detected with frequencies similar to the ones described by the literature. It seems that comorbidities, as the presence of diabetes, may influence tendon degeneration or rupture. Conclusions. Although it included a relatively low number of subjects, our paper reveals data similar to the ones previously published and underlines the necessity of applying an algorithm for managing shoulder pathology, that should mandatory include ultrasonography examination, in order to obtain an accurate diagnosis and individualize each patient's therapeutic approach and improve their life quality.

Diagnostic and therapeutic value of ultrasonography in the detection of paralabral ganglion cysts with a curved array transducer: A case report

BACKGROUND: Paralabral cysts are a rare cause of shoulder pain. Linear ultrasound transducers are often used for musculoskeletal evaluation and intervention. However, the use of linear transducer is limited when the target structure is located deep and blocked by bony barriers, as is the case of paralabral ganglion cysts. OBJECTIVE: This case report aims to describe a beneficial role of using a convex transducer on the evaluation and ultrasonography-guided intervention of paralabral cysts below the acromion. CASE DESCRIPTION: Two patients visiting the outpatient clinic of Physical Medicine and Rehabilitation complained of severe pain during shoulder movement. Ultrasound scans with linear transducer detected rotator cuff lesions. Shoulder MRIs performed because of persistent pain despite ultrasound-guided bursa injection at the subacromial-subdeltoid bursa using a linear array transducer, confirmed paralabral cysts. Although a linear array transducer could not visualize the lesion but could only perform suprascapular nerve block and intra-articular injection, the use of a convex array transducer improved the visualization of the cystic lesion which we treated using ultrasound-guided aspiration and intra-cystic injection. Visual analog scale and Shoulder Pain and Disability Index were checked to assess the treatment effect of each intervention. The intra-cystic injection with aspiration and intra-articular injection showed minimal to moderate improvement of pain score. CONCLUSION: In pain related to shoulder movement, especially pain that continues despite appropriate treatment for rotator cuff lesions, ultrasound diagnosis of paralabral ganglion cysts using convex transducers will improve the diagnostic value and accuracy of intervention.

Quantitative Ultrasonographic Analysis of Changes of the Suprascapular Nerve in the Aging Population With Shoulder Pain

BackgroundOlder people are vulnerable to painful shoulder syndromes, the majority of which are derived from degenerative rotator cuff pathologies. The suprascapular nerve (SSN) is closely related to the rotator cuff complex, and its role in shoulder pain has recently been highlighted. This study aimed to explore the differences in SSN among older people with and without shoulder pain, and to investigate the potential factors influencing the nerve size using ultrasound (US) imaging.MethodsParticipants aged ≥60 years were enrolled in the study. A systematic and bilateral US examination of the rotator cuff tendons was performed. The SSN was examined from its origin in the brachial plexus to the spinoglenoid notch of the infraspinatus fossa. The association between the nerve’s cross-sectional area (CSA) and rotator cuff lesions was analyzed using the generalized estimation equation.ResultsAmong the 94 participants, 45 (with bilaterally asymptomatic shoulders) were classified into the control group, whereas 49 (with at least one-sided shoulder pain) were classified into the group with shoulder pain. The average CSAs of the SSN at the level of the brachial plexus, supraspinatus fossa, and infraspinatus fossa were comparable between the patients in the control group and those with shoulder pain. There was a higher prevalence of rotator cuff lesions and enlarged distal SSNs in the painful shoulders than in the asymptomatic shoulders of patients with unilateral involvement. A full-thickness tear of the supraspinatus tendon was associated with swelling of the SSN in the supraspinatus fossa (β coefficient = 4.068 mm2, p < 0.001).ConclusionIn the older population, full-thickness tears of the supraspinatus tendon are independently associated with enlargement of the distal SSN. In cases with large rotator cuff tendon tears with poor response to conservative treatments, possible SSN entrapment should be considered and managed accordingly.

MAGNETIC RESONANCE IMAGING CHARACTERISTICS AND ADDED VALUES OF X-RAY AND ULTRASONOGRAPHY IN DIAGNOSIS OF ROTATOR CUFF LESIONS

Purpose: To study magnetic resonance imaging characteristics and the added values of x-ray and ultrasonography in diagnosis of rotator cuff lesions. Material and method: 45 patients with clinical suspected rotator cuff lesions were recruited from may 2018 to august 2019 at Hue University of Medicine and Pharmacy Hospital. Patients undergone X-ray, Ultrasonography, and Mri of shoulder joint. The X ray and sonographic features were compared to MRI results to evaluate the added value of X-ray and ultrasonography in diagnosing rotator cuff lesions. Results: Ultrasound detected supraspinatus tear in 86.7%, tendonitiss in 40% and tenosynovitis in 8.9% of cases. X-ray detected suggestive features of supraspinatus tendon injuries in 88.9% of cases. Patients with two or more suggestive features was 46.7% with greater tuberosity sclerosis and calcification at the attachment site of tendon were the most common findings. The relationship between diagnosis of supraspinatus tendon tear, tendonitis and tenosynovitis on ultrasound with the number of suggested features on X-rays was 0.02, 0.564, 0.89. Conclusion: X-ray have supportive value for ultrasound in diagnosis of supraspinatus tendon tear. Keywords: Rotator cuff tear, MRI and Ultrasonography rotator cuff tear, The value of Ultrasonography in Rotator cuff lesions.