Clinics in Shoulder and Elbow最新文献

We describe the case of a 49-year-old right hand-dominant woman with myositis of the biceps brachii muscle unrelated to the inoculation site following Pfizer-BioNTech COVID-19 vaccination on the deltoid muscle of the left shoulder. Coronavirus disease 2019 (COVID-19) pandemic has involved global spread, and different vaccines including inactivated, protein, vectored, and nucleic acid vaccines have been developed and administered. Common side effects of COVID-19 vaccines include general manifestations such as headache, fever, and fatigue, and various musculoskeletal symptoms. Here, we present a case of myositis occurring in the biceps brachii muscle unrelated to the inoculation site, which has not been reported previously, accompanied by a literature review.

Background: Arm swing plays a role in gait by accommodating forward movement through trunk balance. This study evaluates the biomechanical characteristics of arm swing during gait.

Methods: The study performed computational musculoskeletal modeling based on motion tracking in 15 participants without musculoskeletal or gait disorder. A three-dimensional (3D) motion tracking system using three Azure Kinect (Microsoft) modules was used to obtain information in the 3D location of shoulder and elbow joints. Computational modeling using AnyBody Modeling System was performed to calculate the joint moment and range of motion (ROM) during arm swing.

Results: The mean ROM of the dominant elbow was 29.7°±10.2° and 14.2°±3.2° in flexion-extension and pronation-supination, respectively. The mean joint moment of the dominant elbow was 56.4±12.7 Nm, 25.6±5.2 Nm, and 19.8±4.6 Nm in flexion-extension, rotation, and abduction-adduction, respectively.

Conclusions: The elbow bears the load created by gravity and muscle contracture in dynamic arm swing movement.

Avascular necrosis (AVN) of the humeral head is a rare, yet detrimental complication. Left untreated, humeral head AVN frequently progresses to subchondral fracturing and articular collapse. Cases of late-stage humeral head AVN commonly require invasive procedures including humeral head resurfacing, hemiarthroplasty, and total shoulder arthroplasty (TSA) to improve clinical outcomes. However, in cases of early-stage AVN, core decompression of the humeral head is a viable and efficacious short-term treatment option for patients with pre-collapse AVN of the humeral head to improve clinical outcomes and prevent disease progression. Several techniques have been described, however, a percutaneous, arthroscopic-assisted technique may allow for accurate staging and concomitant treatment of intraarticular pathology during surgery, although further long-term clinical studies are necessary to assess its overall outcomes compared with standard techniques. Biologic adjunctive treatments, including synthetic bone grafting, autologous mesenchymal stem cell/bone marrow grafts, and bone allografts are viable options for reducing the progression of AVN to further collapse in the short term, although long-term follow-up with sufficient study power is lacking in current clinical studies. Further long-term outcome studies are required to determine the longevity of core decompression as a conservative measure for early-stage AVN of the humeral head.

Elbow traumas represent a relatively common condition in clinical practice. However, there is a lack of evidence regarding the most accurate tests for screening these potentially serious conditions and excluding elbow fractures. The purpose of this investigation was to analyze the literature concerning the diagnostic accuracy of clinical tests for the detection or exclusion of suspected elbow fractures. A systematic review was performed using the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines. Literature databases including PubMed, Cumulative Index to Nursing and Allied Health Literature, Diagnostic Test Accuracy, Cochrane Library, the Web of Science, and ScienceDirect were searched for diagnostic accuracy studies of subjects with suspected traumatic elbow fracture investigating clinical tests compared to imaging reference tests. The risk of bias in each study was assessed independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies 2 checklist. Twelve studies (4,485 patients) were included. Three different types of index tests were extracted. In adults, these tests were very sensitive, with values up to 98.6% (95% confidence interval [CI], 95.0%-99.8%). The specificity was very variable, ranging from 24.0% (95% CI, 19.0%-30.0%) to 69.4% (95% CI, 57.3%-79.5%). The applicability of these tests was very high, while overall studies showed a medium risk of bias. Elbow full range of motion test, elbow extension test, and elbow extension and point tenderness test appear to be useful in the presence of a negative test to exclude fracture in a majority of cases. The specificity of all tests, however, does not allow us to draw useful conclusions because there was a great variability of results obtained.

Background: Massive rotator cuff tears (RCTs) are complicated by muscle atrophy, fibrosis, and intramuscular fatty degeneration, which are associated with postoperative tendon-to-bone healing failure and poor clinical outcomes. We evaluated muscle and enthesis changes in large tears with or without suprascapular nerve (SN) injury in a rat model.

Methods: Sixty-two adult Sprague-Dawley rats were divided into SN injury (+) and SN injury (-) groups (n=31 each), comprising tendon (supraspinatus [SSP]/infraspinatus [ISP]) and nerve resection and tendon resection only cases, respectively. Muscle weight measurement, histological evaluation, and biomechanical testing were performed 4, 8, and 12 weeks postoperatively. Ultrastructural analysis with block face imaging was performed 8 weeks postoperatively.

Results: SSP/ISP muscles in the SN injury (+) group appeared atrophic, with increased fatty tissue and decreased muscle weight, compared to those in the control and SN injury (-) groups. Immunoreactivity was only positive in the SN injury (+) group. Myofibril arrangement irregularity and mitochondrial swelling severity, along with number of fatty cells, were higher in the SN injury (+) group than in the SN injury (-) group. The bone-tendon junction enthesis was firm in the SN injury (-) group; this was atrophic and thinner in the SN injury (+) group, with decreased cell density and immature fibrocartilage. Mechanically, the tendon-bone insertion was significantly weaker in the SN injury (+) group than in the control and SN injury (+) groups.

Conclusions: In clinical settings, SN injury may cause severe fatty changes and inhibition of postoperative tendon healing in large RCTs. Level of evidence: Basic research, controlled laboratory study.

Background: The management of acromioclavicular (AC) joint dislocation remains controversial. Recently, anatomic coracoclavicular (CC) fixation with a double clavicular tunnel and three flip-buttons has shown promising results. This study aimed to evaluate functional and radiological outcomes in patients with high-grade AC joint dislocation treated with anatomic CC fixation using double clavicular tunnels and three flip-buttons.

Methods: A retrospective, unicentric study was performed. The study included patients with high-grade AC joint dislocation who underwent surgery with anatomic CC fixation using double clavicular tunnels and three flip-buttons. Demographic data were obtained from medical records. A functional evaluation using subjective shoulder value (SSV), visual analog scale (VAS), and disabilities of the arm, shoulder, and hand (DASH) questionnaires was performed, and an evaluation of preoperative and postoperative comparative Zanca view images was performed. Factors associated with functional outcomes and radiological AC reduction were analyzed.

Results: A total of 83 patients completed follow-up and were included in the analysis. The mean SSV, VAS, and DASH scores were 92.8, 0.8, and 6.4, respectively. Patients who had complications experienced significantly worse functional outcomes (DASH: P=0.037). Suboptimal final AC reduction was observed in nine patients (11.1%), and significantly more frequently in patients older than 40 years (P=0.031) and in surgeries performed more than 7 days after injury (P=0.034). There were two reoperations (2.4%).

Conclusions: Anatomic CC fixation with a double clavicular tunnel and three flip-buttons leads to good functional outcomes, low complication rates, and high rates of optimal AC reduction. Level of Evidence: Level IV; Case series.

Background: We analyzed association between viewing two-dimensional computed tomography (2D CT) images in addition to radiographs with radial head treatment recommendations after accounting for patient and surgeon factors in a survey-based experiment.

Methods: One hundred and fifty-four surgeons reviewed 15 patient scenarios with terrible triad fracture dislocations of the elbow. Surgeons were randomized to view either radiographs only or radiographs and 2D CT images. The scenarios randomized patient age, hand dominance, and occupation. For each scenario, surgeons were asked if they would recommend fixation or arthroplasty of the radial head. Multi-level logistic regression analysis identified variables associated with radial head treatment recommendations.

Results: Reviewing 2D CT images in addition to radiographs had no statistical association with treatment recommendations. A higher likelihood of recommending prosthetic arthroplasty was associated with older patient age, patient occupation not requiring manual labor, surgeon practice location in the United States, practicing for five years or less, and the subspecialties "trauma" and "shoulder and elbow."

Conclusions: The results of this study suggest that in terrible triad injuries, the imaging appearance of radial head fractures has no measurable influence on treatment recommendations. Personal surgeon factors and patient demographic characteristics may have a larger role in surgical decision making. Level of evidence: Level III, therapeutic case-control study.

The glenohumeral joint is one of the most commonly dislocated joints. When dislocated, the humeral head typically moves anteriorly and medially within the soft tissues adjacent to the glenoid. We present a case of a 64-year-old female who presented with a locked anterior shoulder dislocation with impaction of the humeral head onto the coracoid. To our knowledge, this is the first reported instance of humeral head impaction onto the coracoid causing the shoulder dislocation to be irreducible by closed means. Complications of this dislocation can include humeral head deformity, pseudoparalysis, brachial plexus injury, and significant pain.

A Monteggia fracture is a proximal ulnar fracture with proximal radioulnar ligamentous instability. While there is no precise definition, Monteggia-equivalent fractures are generally considered Monteggia fractures accompanied by radial head fractures. These are rare. In this study, we report a rare variation of a Bado type IV Monteggia-equivalent lesion (fracture of proximal ulnar shaft, proximal radial shaft, and radial head) and its management.