Biceps Tenotomy Vs Tenodesis in Patients Younger Than 50, Systematic Review

Purpose: The objective of this meta-analysis was to offer an up-to-date comparison of clinical outcomes of tenotomy and tenodesis in the surgical treatment of LHB tendinopathy in patients under the age of 50. Methods: A literature search was conducted in EMBASE, PubMed/Medline and the Cochrane database from January 2010 to Dec 2020. All studies that compared the clinical results of LHB tenotomy and tenodesis were included. Results: The Meta- analysis data were from nine studies that comprised 669 participants who had LHB tenotomy or tenodesis with or without other shoulder surgeries (mainly rotator cuff repairs). There were no clinically significant changes in the Constant score, the American Shoulder and Elbow Society Score, shoulder pain, elbow flexion strength loss, or forearm supination strength when tenodesis and tenotomy were compared in randomized studies. Patients who have tenodesis were less likely to develop a Popeye deformity. Conclusion: In a meta-analysis, patients who had a tenotomy were more likely to have a Popeye deformity. There is no evidencebased benefit of LHB tenodesis over tenotomy in terms of shoulder function, shoulder discomfort, or biceps-related strength, according to a large number of studies. It's unknown whether LHB tenodesis is beneficial to some patient populations, such as children. Keywords: Biceps, Tenotomy, Tenodesis, Rotator cuff, Meta-analysis

Isokinetic and functional shoulder outcomes after arthroscopic capsulolabral stabilization

Introduction Shoulder stability is secured by dynamic and static stabilizers. Rotator cuff is responsible for dynamic stabilization. In cases of shoulder instability their activity is disturbed. Capsulolabral repair restores mainly static stabilization. This surgery treatment technique of shoulder instability was first described by Bankart in 1923. His idea, with further modifications, is commonly used up to this day. Evaluation of muscle shoulder recovery after stabilization should be one of the important criteria to allow patient to return to sport and work. However, not much isokinetic assessment after capsulolabral repair was described. The aim of this study were the following: the comparative assessment of the shoulder rotatory strength in patients following arthroscopic capsulolabral repair of unilateral anterior traumatic instability and clinical assessment with comparison of pre and post-operative results. Material and methods Forty-five patients, 14 women and 31 men, with an average follow-up of 4.4 years were tested bilaterally for internal and external rotation strength at four angular velocities. ASES and UCLA tests were collected before and after surgery. Results The values of peak moment and muscle power parameters were slightly lower for an operated shoulder in comparison to a healthy shoulder for the external rotation. Total work parameter in external rotation was significantly lower for the operated shoulder in comparison to the non-operated side. The internal/external muscle group balance was lower for the operated shoulder in comparison to reference values in the women group. Furthermore, both ASES and UCLA scores were significantly higher after operation. Conclusions After arthroscopic capsulolabral shoulder stabilization, slight differences in isokinetic evaluation, especially in external shoulder rotation, occur. It affects rotators muscle balance. In functional evaluation significant improvement in shoulder function occurs.

Comparative study of plating versus conservative treatment in mid shaft fractures of clavicle

<p><strong>Background</strong>: Clavicle fractures represent up to 4% and 1% of all fractures, respectively. Historically, both fracture types have been treated conservatively with acceptable outcomes. The surgical correction of these fractures is currently being investigated as a viable alternative to conservative management.</p><p><strong>Methods</strong>: A systematic search of PubMed was performed to identify articles comparing open reduction and internal fixation (ORIF) with conservative treatment for clavicular fractures. Specific outcomes of interest were shoulder function, pain, strength, range of motion, and risk of non-union. </p><p><strong>Results</strong>: ORIF of midshaft clavicular fractures results in increased shoulder function within 6 weeks following treatment and a decreased risk of non-union. After 1 year, there was no longer a difference in shoulder function between groups. There was no difference in pain between treatment groups. Both ORIF and conservative treatment of extraarticular scapular fractures yield comparable results in shoulder function, range of motion, and strength following treatment.</p><p><strong>Conclusions</strong>: This study, early primary plate fixation of comminuted mid shaft clavicular fractures results in improved patient-oriented outcomes, improved surgeon-oriented outcomes, earlier return to function and decreased rates of non-union and malunion. </p>

Arthroscopic Resection of Humeral Enchondroma

Enchondromas are common benign bone tumors. They are often found incidentally and usually do not require any treatment other than clinical surveillance. Signs of lesion progression or nontolerable pain are criteria for surgical resection. We present a case of a 44-year-old woman with long-lasting shoulder pain, diagnosed with enchondroma. Imaging studies showed an enchondroma near the great tuberosity. Shoulder arthroscopy made it possible to diagnose and treat an SLAP lesion as well as to resect by curettage and shaving through the subacromial lateral portal. One year after surgery, the patient had significant pain relief and improved shoulder function. Shoulder arthroscopy seems to be a safe and suitable technique for resection of small-sized humeral enchondromas, with the advantage of allowing to treat other possible concomitant shoulder pathologies.

Physiotherapy Rehabilitation in Arthroscopic Rotator Cuff Repair Patient- A Case Report

Rotator cuff pathology is usual, and the ailment's natural history suggests that tears enlarge with age. Rotator cuff tears are a familiar origin of pain and ailment in the shoulder. The research on treatment of rotator cuff tears is mixed. The aim of this review is to evaluate the evidence regarding the effectiveness of physiotherapy in lowering pain and enhance shoulder function in patients with symptomatic rotator cuff tears. Rotator cuff injuries are typically followed by a gradual onset of pain, but they can also be the result of an acute injury. Chronicity, underlying anatomic and physical factors, age, and the presence and severity of tendon tears all influence how rotator cuff conditions are managed. Conservative care, such as physical therapy, is typically used as the first line of defence, but surgical repair may be required later on. Rotator cuff (RC) tears can range from partial to full thickness tears of a single tendon to massive cuff tears. Rotator cuff tearing can be caused by glenohumeral trauma as well as pathological process. As a result, Treatment necessitates a diligent diagnosis as well as a distinguished approach that considers morphological and patient-specific effects. The therapeutic approach is determined by the patient's pathogenicity, tear morphology, clinical symptoms, and functional demands. The current case is about an 51 year old male who was admitted to the hospital with tear injury to right shoulder due to fall from truckmuscle strength and range of motion were main focus of physiotherapy intervention. The prime goal of this case study was to assess the patient’s response to physiotherapy for reinforcement and functional task.

Shoulder Function and Fatty Infiltration on MRI in Older Adults During Rehabilitation for Rotator Cuff Tear

Rotator cuff tear is highly prevalent in older adults, with supraspinatus tendon tear (STT) the most common. Shoulder rehabilitation is a major treatment strategy, but supraspinatus-muscle-fatty infiltration (FI) and shoulder function in older adults with rotator cuff tear primarily managed by physical therapy (PT) is inadequately documented. We tested the hypothesis that older adults receiving usual-care PT when stratified by supraspinatus tear-status differ in supraspinatus FI [by quantitative Dixon fat fraction (FF) and semi-quantitative Goutallier grade (GG) on MRI] and shoulder function [by the American Shoulder and Elbow Surgeons score (ASES-score)] over time. Longitudinal cohort study (pilot): adults 60-85 years, PT-cohort (n=15) and control-cohort (n=25). Participants completed both shoulder MRI and ASES survey at baseline and follow-up visits. Kruskal-Wallis test compared within cohort among 3 groups: no tear (no-STT), partial-thickness tear (pt-STT), full-thickness tear (ft-STT). Mann-Whitney U test compared equivalent groups between cohorts. Baseline PT-cohort groups differed for GG (p=0.033) [no tear, 0.50±0.50;pt-STT, 1.11±0.22;ft-STT, 1.50±0.50] without difference in age, BMI, comorbidity, or ASES-score. Baseline control-cohort groups differed for FF (p=0.034) [no-tear, 5.77%±1.16%;pt-STT, 7.14%±6.26%;ft-STT, 21.44%±10.44%], without difference in age, BMI, comorbidity, or ASES-score. Baseline no-tear groups for ASES-score (p=0.049) differed between cohorts: PT-cohort (58.87±8.21) versus control-cohort (83.98±21.89). Both cohorts showed no difference in Δ-FF or Δ-GG over time. PT-cohort groups differed for Δ-ASES-score over time (p=0.042)[no-tear, 16.65±4.69;pt-STT, -7.24±0.94;ft-STT, 4.48±3.45], but control-cohort groups did not (p&gt;0.050). Our results suggest differences exist for supraspinatus FI and self-reported shoulder function among older adults receiving PT for rotator cuff tear when stratified by supraspinatus tear-status.

Validation of the Korean Version of the Neck Dissection Impairment Index in Patients Who Underwent Neck Dissection

Background/Objectives: Shoulder function is an important aspect of health related quality of life (QOL). Neck dissection impairment index (NDII) is a simple shoulder-specific questionnaire. This study aimed to evaluate the association between QOL and NDII in patients who underwent neck dissection to validate the Korean version of NDII.Materials & Methods: This study enrolled 74 patients with head and neck cancer who underwent neck dissection from December 2013 to April 2014. Patients completed questionnaires on QOL including the European Organization of Research and Treatment of Cancer 30-item Core QOL questionnaire (EORTC QLQ-C30) and NDII which was translated into Korean. Validity was evaluated by calculating the Pearson correlation coefficient between NDII and EORTC QLQ-C30.Results: We compared preoperative, postoperative within a week, 1st and 3rd months NDII scores. The total NDII scores were 14.7, 47.4, 33.7 and 34.3 each. Clinical variables including gender, site of primary tumor, performing revision neck dissection, radiotherapy and flap reconstruction were not significantly associated with NDII. However NDII mean score of patients who underwent unilateral neck dissection over 3 levels is most increased after operation. During all periods NDII scores were significantly associated with functioning score. Although other scores are lower correlation than function scores, global health status scores and symptom scores are also correlation with NDII.Conclusion: NDII was valid instrument and can be used not only in the clinical practice to assess shoulder dysfunction but also in the simple instrument to evaluate global QOL in Korea patients with having neck dissection.

An unusual case of anteroinferior paralabral cyst with axillary nerve compression: A case report

Paralabral cysts are an uncommon cause of shoulder pain in young adults. Their association with neurological symptoms is seldom reported in the literature. The cysts are believed to develop when there is a labral tear allowing synovial fluid entry into tissues causing one-way valve effect. This case report describes a case of anteroinferior paralabral cyst in a painful shoulder associated with axillary nerve palsy. MRI revealed an anteroinferior labral cyst. Electromyography revealed denervation of deltoid and teres minor muscles. Shoulder arthroscopy was performed with cyst decompression and labral repair. Shoulder function improved gradually and by the end of 1 year, power was back to pre-injury status. Paralabral cysts are a rare entity. When associated with nerve injury, prompt decompression is necessary to prevent irreversible nerve and muscle damage.