Clinics in Shoulder and Elbow最新文献

Brachial plexus paralysis is a rare but serious complication following clavicle fractures that is often linked to neurovascular compression, with an incidence of 0.5% to 9.0%. This report presents a case of brachial plexus paralysis in a 61-year-old woman after surgical fixation of a deformed mid-clavicle fracture with a metal plate. Revision surgery was performed to address the paralysis, involving removal of the metal plate, arcuate osteoplasty to create a smooth arch beneath the clavicle, and re-fixation of the plate with adjusted superior angularity. We used this approach to relieve neurovascular compression and restore thoracic outlet space. Over a period of 1 year, significant recovery and successful fracture union were achieved. This case demonstrates that managing brachial plexus paralysis with revision surgery and osteoplasty can effectively restore both neurological function and bone healing.

Degenerative rotator cuff disease (RCD) is a common musculoskeletal condition that disproportionately affects individuals with diabetes mellitus, leading to pain, functional impairment, and a reduced quality of life. Emerging evidence suggests that sodium-glucose co-transporter 2 inhibitors (SGLT2is), which are widely used for glycemic control in type 2 diabetes, offer additional musculoskeletal benefits beyond their metabolic effects. This review explores the potential protective role of SGLT2is in diabetic RCD by examining the epidemiological link between diabetes and tendon degeneration and evaluating the biological mechanisms through which SGLT2 is influence tendon health. These potential benefits include reducing inflammation, altering metabolism to a more tendon-friendly state, combating oxidative stress with ketones, encouraging a healing environment through macrophage modulation, and improving overall health via weight and blood sugar management. Preclinical and observational studies provide preliminary support for therapeutic benefits, although high-quality randomized clinical trials are lacking. Understanding the multifaceted role of SGLT2is in tendon biology will open new avenues for prevention and management of RCD, particularly in patients with metabolic disorders.

Background: Allograft prosthetic composite (APC) and megaprosthesis (MP) have both been used to reconstruct the proximal humerus after its resection due to primary or secondary tumors. However, varied results have been reported in the literature with no consensus on which reconstruction has better overall outcomes.

Methods: PubMed, Cochrane, and Google Scholar (pages 1-20) were queried through September 2024. The compared outcomes consisted of adverse events, patient-reported outcomes measures, and range of motion. Ten studies and 400 patients were included, with 115 in the APC group and 285 in the MP group.

Results: The APC group had a higher rate of reoperations (odds ratio, 2.50; 95% CI, 1.40-4.45; P=0.002) than did the MP group over an average follow-up of 7.0 years. However, better postoperative flexion (mean difference, 10.11; 95% CI, 5.33-14.90; P<0.001) and Musculoskeletal Tumor Society scores (mean difference, 3.73; 95% CI, 1.37- 6.08; P=0.002) were seen in the APC group.

Conclusions: The present study shows a lower rate of revision with the use of MP but better functional outcomes and forward flexion with APC as the surgical option for proximal humerus reconstruction. Level of evidence: III.

Background: Accurate measurement of glenoid version is essential for optimal implant positioning in shoulder arthroplasty. This study compared the accuracy and reliability of unformatted two-dimensional computed tomography (2D-CT), formatted 2D-CT, and three-dimensional CT (3D-CT) reconstructions in measuring glenoid version.

Methods: Shoulder CT scans for arthroplasty were analyzed retrospectively. Glenoid version was measured at the estimated glenoid midpoint using unformatted and formatted 2D-CT in the scapular plane. Measurements from 3D-CT reconstructions using the Corrected Friedman Method were used as the control. Inter- and intra-observer reliability was calculated as well as minimally detectable difference.

Results: Sixty-five CT scans were analyzed (mean age, 61.7 years). Mean glenoid version was -3.48° (standard deviation [SD], 8.7°) on unformatted 2D-CT, -3.27° (SD, 8.15°) on formatted 2D-CT, and -4.25° (SD, 7.92°) on 3D-CT. Although no significant difference in mean values was observed (analysis of variance, P=0.245), formatted 2D-CT measurements were within 6° of 3D-CT in 95.4% of cases versus 83.1% for unformatted 2D-CT (P=0.023). Directional error occurred in 27.7% of unformatted scans and 16.9% of formatted scans. Inter-observer reliability was highest for 3D-CT (intraclass correlation coefficient [ICC]=0.83; 95% CI, 0.74-0.89), and intra-observer agreement was strongest for 3D-CT (ICC=0.91; 95% CI, 0.86-0.94), followed by formatted 2D-CT (ICC=0.83; 95% CI, 0.73-0.89) and unformatted 2D-CT (ICC=0.77; 95% CI, 0.65-0.85).

Conclusions: 3D-CT reconstructions are widely considered the most accurate and reproducible method for glenoid version assessment, supported by multiple comparative imaging studies. Formatted 2D-CT provides a reliable alternative when 3D-CT is unavailable, significantly outperforming unformatted 2D-CT in both agreement with the 3D reference and intra- and inter-observer reliability. Level of evidence: IV.

Background: YouTube is a widely accessible platform that facilitates the rapid dissemination of both evidence-based and potentially misleading health-related information. This study assesses the educational quality, reliability, and comprehensiveness of the most-viewed YouTube videos about scapular dyskinesis.

Methods: A systematic search was conducted on YouTube using the keywords "scapular dyskinesia" and "scapular dyskinesis." The top 100 videos for each keyword were screened for inclusion, and the metrics, sources, and content of the included videos were analyzed. Video quality and reliability were assessed using the Global Quality Scale and the modified DISCERN scale, respectively. In addition, a newly developed, non-validated tool, Scapular Dyskinesis Specific Scoring, was used to provide a condition-specific content assessment.

Results: The analysis revealed that 48.1% of the videos were low quality, and 62.0% lacked reliability. Videos produced by health-related websites exhibited superior quality. Content focusing on treatment and diagnostic approaches demonstrated significantly higher quality than other content categories (P<0.001). A correlation analysis indicated that the Video Power Index did not correlate significantly with reliability, quality, or comprehensiveness scores. Additionally, a simple regression analysis revealed that the video upload time negatively affected the quality, reliability, and comprehensiveness metrics.

Conclusions: Most YouTube videos on scapular dyskinesis were of low quality, lacked reliability, and failed to provide comprehensive and accurate information. Furthermore, high-quality and reliable content tended to receive relatively low engagement and user preference scores. These findings underscore the urgent need for well-structured, evidence-based, and regularly updated YouTube content about scapular dyskinesis. Level of evidence: IV.

Background: Shoulder arthroscopy is associated with a steep learning curve. Virtual reality (VR) arthroscopic simulator training has recently gained prominence as a promising training modality for shoulder arthroscopy. However, there is a lack of high-quality evidence regarding its efficacy. Thus, in this study we perform a systematic review to investigate the effects of VR simulator in shoulder arthroscopy training.

Methods: We performed a systematic search of four databases (PubMed, Embase, Scopus, and Cochrane Library). Studies that compared outcomes pre- and post-VR training as well as outcomes between VR groups and control (non-VR/low fidelity) groups were included. Primary outcomes between VR and control consisted of time to completion and arthroscopic evaluation score. Additionally, pre- versus post-training improvement in arthroscopic evaluation score was evaluated.

Results: Seven studies were included in this systematic review. Total cohort size was 143, with 93 in the VR group and 50 in the control group. Studies that compared time to completion in VR and control groups all showed significantly shorter time to completion in the VR group, with individual study standardized mean difference (SMD) ranging from -0.24 to -1.37. In terms of arthroscopic evaluation score, several studies showed pre- to post-training improvement in (individual SMD range, 0.32 to 2.32) but no difference between VR and control groups (individual SMD range, -0.02 to 0.82).

Conclusions: In this study we found that VR training results in shorter task completion time for trainees, whereas there are no differences in arthroscopic evaluation scores between VR versus control groups. Hence, VR simulator training improves arthroscopic efficiency for orthopedic trainees, with limited improvement in quantitative skills. Level of evidence: II.

Shoulder instability, particularly anterior instability, remains a significant clinical and socioeconomic burden, especially in young, active populations. Recent advancements have refined our understanding of critical and subcritical bone loss, bipolar lesions, and dynamic stabilization concepts. This review synthesizes current evidence by analyzing recent clinical studies, biomechanical research, and technological developments related to the management of anterior shoulder instability. While traditional soft-tissue procedures such as the Bankart repair maintain a role in select low-risk patients, emerging data support earlier consideration of bony augmentation or dynamic stabilization in high-risk cohorts. Moreover, technologies such as dynamic anterior stabilization, arthroscopic Latarjet procedures, suture-button fixation, and biologic augmentation strategies are redefining treatment algorithms. Recent advances have reshaped the approach to shoulder instability, emphasizing individualized strategies based on bone loss, patient risk profile, and dynamic stabilizing techniques. An evidence-based framework is essential for optimizing clinical outcomes.

Background: This cadaveric study investigated whether radiolucent lines (RLLs) in x-rays of uncemented polyethylene (PE) glenoid implants with a thin titanium layer at the back can appear or disappear due to tilting of the x-ray projection.

Methods: Eight RM Pressfit Vitamys glenoids (Mathys) were implanted in cadaveric scapulae. A computed tomography (CT) scan confirmed where the PE implant was flush with bone and where a gap was present. In addition to the 0° projection as a starting point, the glenoid was tilted in 10° and 20° retro- and anteversion and superior and inferior tilt directions. The glenoid was subdivided into five zones. Each zone was quantified with no RLLs or RLLs.

Results: In all zones, tilting from 0° to 10° inferior tilt (P=0.028), 10° retroversion (P<0.001), and 20° anteversion (P<0.001) caused RLLs to appear or disappear. Tilting from 0° to 20° inferior tilt (P=0.087), 10° (P=0.218) and 20° superior tilt (P=0.484), and 10° anteversion (P=0.126) did not cause any RLLs to appear or disappear. The RLLs always disappeared at 20° retroversion.

Conclusions: True anteroposterior images should be obtained during x-ray assessment following uncemented glenoid component implantation. A CT scan is advised to confirm or exclude the presence of RLLs. Level of evidence: Laboratory cadaveric study.

Background: The aim of this study is to assess the diagnostic value of the alpha-defensin lateral flow (ADLF) test in a group of patients with suspected shoulder periprosthetic joint infections (PJIs) and its usefulness and correlation with other diagnostic tests in the decision-making process.

Methods: This retrospective single-center study was conducted between 2018 and 2023. Alpha-defensin was measured using an ADLF test kit. The final diagnosis of shoulder PJI was confirmed or ruled out based on the Musculoskeletal Infection Society criteria.

Results: After selecting patients based on the exclusion criteria, the final study group comprised 22 patients. Of all patients, the test was positive in five cases. The ADLF test was false-positive in two patients and was false-negative in zero patients. The test was truly negative in 17 cases, resulting in a sensitivity of 100.00% (95% CI, 100.00%-100.00%) and a specificity of 89.47% (95% CI, 76.65%-102.30%). The positive predictive value was 60.00% (95% CI, 39.53%-80.47%) and the negative predictive value was 100.00% (95% CI, 100.00%-100.00%). The accuracy of the α-defensin test was found to be 90.9%.

Conclusions: Although this study has limitations such as small sample size and research design, the ADLF test has proven to be a useful diagnostic tool. It can serve as a supplement to traditional tests, providing additional support to orthopedic surgeons in both preoperative and intraoperative diagnosis, especially in its ability to exclude the possibility of a PJI. Level of evidence: III.