In order to restore the function of shoulder joint in patient with tumor of upper end of humerus, artificial humeral head replacement was performed. The materials included resinene, nylon-6 and large molecular polyethylene from 1978 to 1993, 14 patients were treated. The tumors involved in this group were giant cell tumor, synviosarcoma, bone cyst, osteochondroma, osteoblastoma, osteofibrosarcoma, osteosarcoma, chondrosarcoma, parosteosarcoma and malignant giant cell tumor. After resection of the tumor, the artificial prosthesis was implanted with bone cement. After 1 to 16 years follow-up, functions of the shoulder joint were reserved in 86% of the patients.
Objective
To investigate the method and effectiveness of coracoplasty with mini-incision for subcoracoid impingement syndrome.
Methods
Between May 2006 and September 2011, 4 patients with subcoracoid impingement syndrome were treated, including 3 cases of congenital dysplasia of the coracoid process and 1 case of anterior glenohumeral instability. There were 3 males and 1 female with an average age of 36 years (range, 20-56 years). The disease duration was 6-22 months (mean, 11.2 months). The patients had a history of chronic pain and click of the anterior should, which was aggravated in adduction, internal rotation, and flexion. The results of the coracoid impingement test were positive by Neer and Hawkins-Kennedy impingement sign. The axial CT in adduction position showed that the coracohumeral interval decreased and coracoid index increased. The 2 cm lateral coracoid incision was made and the 0.5-1.5 cm coracoid neck was revealed and cut by osteotomy. The coracoplasty was performed by amputating the conjoined tendon insertion of the short head of the biceps and the coracobrachialis muscle and suturing to proximal coracoid osteotomy surface. Shoulder was fixed with the external braces for 6 weeks.
Results
Healing of incision by first intention was observed in all cases without any complication. All the 4 patients were followed up from 8 months to 5 years. At last follow-up, pain and click disappeared. The mean visual analogue scale (VAS), University of California at Los Angeles (UCLA), Constant, and simple shoulder test (SST) scores were significantly improved from 7.75, 10.25, 65.50, and 9.75 at preoperation to 0.25, 34.25, 91.25, and 0.25 at last follow-up respectively. The axial CT in adduction position and MRI showed that long coracoid process was removed; the coracohumeral interval was increased to 13.38 mm from 4.16 mm at preoperation; and the coracoid index was decreased to 0.28 mm from 13.08 mm at preoperation.
Conclusion
Coracoplasty with mini-incision is an effective method to relieve clinical symptoms of subcoracoid impingement, which has less complications and faster recovery.
ObjectivesTo systematically review the clinical efficacy of ultrasound-guided percutaneous lavage (UGPL) for calcifying tendinitis of rotator cuff.MethodsPubMed, The Cochrane Library, EMbase, WanFang Data, CBM, VIP and CNKI databases were electronically searched to collect the randomized controlled trials (RCTs) of ultrasound-guided percutaneous irrigation for calcifying tendinitis of rotator cuff from inception to September 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 7 RCTs involving 587 patients were included. The results of meta-analysis showed that: there were significant differences between the UGPL group and extracorporeal shock wave therapy (ESWT) group in 12-month follow-up visual analogue scale (VAS) (MD=–1.96, 95%CI –2.18 to –1.75, P<0.000 01), the average particle size of the calcium deposition (MD=–3.13, 95%CI –5.05 to –1.22,P<0.001), the calcification disappearance rate (RR=1.65, 95%CI 1.36 to 2.01,P<0.000 01). However, there were no significant differences between the two groups in 6-week follow-up VAS (MD=–0.85, 95%CI –2.84 to 1.14,P=0.40), and the complications (RR=1.20, 95%CI 0.03 to 49.69, P=0.93).ConclusionsCurrent evidence shows that UGPL has certain clinical effect for the calcifying tendinitis of rotator cuff. Compared with ESWT, UGPL may be superior in clinical pain relief and calcification clearance. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo compare the mid-term effectiveness of arthroscopic shoulder capsular release combined with acromiohumeral distance (AHD) restoration in the treatment of diabetic secondary stiff shoulder and primary frozen shoulder. Methods A retrospective analysis was conducted on clinical data of 22 patients with diabetic secondary stiff shoulder (group A) and 33 patients with primary frozen shoulder (group B), who underwent arthroscopic 270° capsular release combined with AHD restoration treatment. There was no significant difference between the two groups in gender, age, affected side, disease duration, and preoperative AHD, shoulder flexion range of motion, abduction range of motion, American Shoulder and Elbow Surgeons (ASES) score, visual analogue scale (VAS) score, and Constant score (P>0.05). Only the difference in the internal rotation cone rank and external rotation range of motion between the two groups showed significant differences (P<0.05). The improvement in shoulder pain and function was evaluated by using VAS score, ASES score, and Constant score before operation and at last follow-up. Active flexion, abduction, external rotation range of motion, and internal rotation cone rank were recorded and compared. AHD was measured on X-ray films.Results All patients were followed up 24-92 months (median, 57 months). There was no significant difference in follow-up time between group A and group B (P>0.05). No fractures or glenoid labrum tears occurred during operation, all incisions healed by first intention, and no complication such as wound infection or nerve injury was observed during the follow-up. At last follow-up, there were significant improvements in active flexion, abduction, external rotation range of motion, internal rotation cone rank, AHD, VAS score, ASES score, and Constant score when compared with preoperative ones in both groups (P<0.05). Except for the difference in change in external rotation range of motion, which had significant difference between the two groups (P<0.05), there was no significant difference in other indicators between the two groups (P>0.05). ConclusionArthroscopic capsular release combined with AHD restoration can achieve good mid-term effectiveness in the treatment of diabetic secondary stiff shoulder and primary frozen shoulder. However, the improvement in external rotation range of motion is more significant in the patients with diabetic secondary stiff shoulder.
ObjectiveTo observe the effect of ultra early joint movement onthe rehabilitation of shoulder joint function in patients with breast cancer who underwent axillary lymph node dissection (ALND).MethodsA total of 100 patients with breast cancer who underwent ALND between August 2018 and December 2019 in Zhongnan Hospital of Wuhan University were randomly divided into the early movement group (n=50) and the ultra early movement group (n=50). Both groups received early rehabilitation intervention as recommended by the guidelines. Patients in the early movement group started the shoulder joint movement training on the 7th day after surgery, and patients in the ultra early movement group started the shoulder joint movement training on the 3rd day after surgery, 3 times a day, 5 days a week, for 4 weeks. The changes in pain and drainage volume 3 days, 1 week, and 2 weeks after surgery and the changes of shoulder joint range of motion 1 week, 2 weeks , and 3 weeks after surgery were compared between the two groups, changes in shoulder function and quality of life 1 week and 3, 6, and 12 weeks after surgery were compared by the Constant-Murley and the Medical Outcomes Study 36-item Short-form Health Survey (SF-36) scales, respectively.ResultsThree days, 1 week, and 2 weeks after surgery, no significant difference in the pain scores or drainage volumes was observed between the two groups (P>0.05). One week, 2 weeks, and 3 weeks after operation, the motion ranges of shoulder abduction, flexion, and external rotation in the ultra early movement group were significantly better than those in the early movement group (P<0.05), and the motion range of shoulder internal rotation 1 week after operation in the ultra early movement group was significantly better than that in the early movement group (P<0.05). One week and 3, 6, and 12 weeks after operation, the Constant-Murley scores in the ultra early movement group were 25.9±4.3, 55.4±5.3, 64.6±4.5, and 73.3±4.6, respectively, which were better than those in the early movement group (21.3±3.8, 48.9±7.8, 57.3±4.7, and 70.7±3.0, respectively; P<0.05). No significant difference in the SF-36 scale scores was observed between the two groups (P>0.05).ConclusionsUltra early joint movement can significantly improve the motion range and functions of shoulder joint in patients with breast cancer who underwent ALND. What’s more, ultra early joint movement does not increase the early drainage volume or pain, and has no significant impact on the later quality of life. It is worthy of clinical application.
OBJECTIVE: To study the reconstructional method and effect of shoulder joint function in the older obstetrical palsy with medial rotation contracture deformity. METHODS: From April 1996 to July 1999, 7 patients of older obstetrical palsy were adopted in this study. Among them, there were 5 males and 2 females, aged from 13 to 21 years old. No previous operation history and the main deformity was medial rotation contracture of shoulder. During operation, these patients were treated with "Z"-shape elongation of the tendon of subscapular muscle, transfer of the tendons of latissimus dorsi and teres major muscle to the tendons of supraspinous and infraspinous muscles. RESULTS: Followed up for 6 to 44 months(averaged 19 months), the Gilbert grading and Mallet scoring were 1.57, 7.57 preoperatively versus 3.45, 10.86 postoperatively, the abduction and external rotation of the shoulder joints recovered obviously. CONCLUSION: It is an effective operation for the older obstetrical palsy with medial rotation contracture of shoulder.
Objective To review the recent research progress on shoulder arthroplasty, and to predict future research direction. Methods Recent l iterature concerned the shoulder arthroplasty was reviewed and analyzed in terms of appl iedanatomy, designs of prosthesis, patterns of prosthesis and fixation ways of prosthesis. Results The shoulder arthroplastyrepresented the treatments of choice for the patients with end-stage shoulder diseases and traumatic diseases. It could provide good and stable results in pain rel ief and functional outcomes. Conclusion There are still many controversies about the patterns of prosthesis, fixation ways and kinds of materials in cl inical practice. Currently, the main research is about the designs of the glenoid prosthesis and the cl inical practice in young patients.
ObjectiveTo investigate the cl inical characteristics of Eyres type V coracoid fracture combined with superior shoulder suspensory complex (SSSC) injuries, and the effectiveness of open reduction and fixation.
MethodsBetween March 2004 and July 2012, 13 patients with Eyres type V coracoid fracture and SSSC injuries were treated. There were 10 males and 3 females with an average age of 41 years (range, 23-59 years). Injury was caused by fall ing from height in 4 cases, by traffic accident in 6 cases, and by impact of the heavy weight in 3 cases. The interval from injury to operation was 3-10 days (mean, 5.2 days). SSSC injuries included 9 cases of acromioclavicular joint dislocation, 5 cases of clavicular fractures, and 4 cases of acromion fractures. The coracoid fractures were fixed with cannulated screws; the acromioclavicular joint dislocations were fixed with hook plate (6 cases) or Kirschner wires (2 case) except 1 untreated case; the clavicular fractures were fixed with anatomical locking plate (3 cases) and hook plate (2 cases); the acromion fractures were fixed with cannulated screws (1 case), Kirschner wires (2 cases), or both of them (1 case).
ResultsThe mean operation time was 158.0 minutes (range, 100-270 minutes), and the mean intraoperative blood loss was 207.7 mL (range, 150-300 mL). The other patients obtained primary healing of incision except 1 patient who had inflammation around incision, which was cured after change dressing. All patients were followed up for 22.6 months on average (range, 17-35 months). All fractures achieved union at a mean time of 3.6 months (range, 2-6 months). No nerve injury and implant fixation failure complications were observed. At last follow-up, the Constant score and the disabil ity of the arm, shoulder, and hand (DASH) score had a significant improvement when compared with scores at pre-operation (P<0.05). The shoulder range of motion in flexion, abduction, and external rotation at last follow-up were significantly higher than those at pre-operation (P<0.05).
ConclusionEyres type V coracoid fracture associated with SSSC injuries usually results in the instabil ity of the shoulder. With individual surgical treatment, the satisfactory function and good effectiveness can be obtained.
In recent years, the development of artificial shoulder arthroplasty has been rapid, but postoperative patients often have problems such as joint swelling, pain, activity limitation, muscle strength decline and various complications, which need to be accompanied by standardized and correct rehabilitation treatment. In this paper, we review the postoperative rehabilitation treatment program of artificial shoulder arthroplasty, the selection of the timing of rehabilitation treatment, the continuity treatment of rehabilitation and the rehabilitation strategies to improve the clinical efficacy in the postoperative period, with a view to providing reference and basis for the development of a reasonable rehabilitation program for postoperative patients.
Objective To assess the therapeutic effect of acupuncture for shoulder hand syndrome after stroke. Methods We searched MEDLINE (1966 to Sep. 2008), EMbase (1980 to Sept. 2008), CBM (1978 to Sept. 2008), VIP (1989 to Sept. 2008), WANFANG Database (1998 to Sept. 2008), CNKI (1979 to Sept. 2008) and handsearched relevant journals and conference proceedings. We included all randomized controlled trials (RCTs) and quasi-RCTs of acupuncture treatment for patients with shoulder hand syndrome. We evaluated the internal validity of the RCTs and quasi-RCTs. If all included trials were of high quality and homogeneity, then the meta-analysis was conducted. Results Three RCTs were identified but due to the defects in quality and clinical differences between the trials, data from these trials were not combined through meta-analysis, and a descriptive analysis was performed. The results showed that acupuncture was effective for treating shoulder hand syndrome. Conclusions The results of our review suggest that acupuncture may be effective for treating houlder hand syndrome, but because of the defects in the methodological quality of included trials, further large sample, double-blind RCTs are urgently needed.
