Shoulder Pain in Swimmers

Even though more swimmers are seeing physicians for shoulder pain, fewer I need to be considered for surgery.     

ACR Appropriateness Criteria on Acute Shoulder Pain

The shoulder joint is a complex array of muscles, tendons, and capsuloligamentous structures that has the greatest freedom of motion of any joint in the body. Acute (<2 weeks) shoulder pain can be attributable to structures related to the glenohumeral articulation and joint capsule, rotator cuff, acromioclavicular joint, and scapula. The foundation for investigation of acute shoulder pain is radiography. Magnetic resonance imaging is the procedure of choice for the evaluation of occult fractures and the shoulder soft tissues. Ultrasound, with appropriate local expertise, is an excellent evaluation of the rotator cuff, long head of the biceps tendon, and interventional procedures. Fluoroscopy is an excellent modality to guide interventional procedures. Computed tomography is an excellent modality for characterizing complex shoulder fractures. Computed tomographic arthrography or fluoroscopic arthrography may be alternatives in patients for whom MR arthrography is contraindicated. A multimodal approach may be required to accurately assess shoulder pathology. The ACR Appropriateness Criteria(?) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.     

Diagnosing an Unusual Cause of Buttock Pain

Osteochondroma can masquerade as a variety of more common soft-tissue overuse disorders. This case involves a 28-year-old runner who reported significant buttock pain. Deep palpation suggested a growth on his ischial tuberosity, and x-rays and CT indicated an osteochondroma. Many patients who have osteochondromas are asymptomatic and therefore require no treatment; however, complete excision relieved this patient's pain. Ruling out malignant transformation is sometimes necessary.     

肩关节疼痛的MRI检查价值评估

目的评价MRI检查对肩关节疼痛疾病诊断的应用价值。方法分析34例肩关节疼痛患者的MRI表现,并与手术所见相对比,评估MRI对疾病诊断的准确性。结果34例患者肩关节磁共振成像扫描发现:肩袖完全撕裂、肩袖部分撕裂、肌腱炎、盂唇撕裂、滑膜炎、关节积液、肱二头肌长头腱鞘炎及肌腱脱位、肿瘤等。13例手术,其中1例MRI诊断为肌腱炎,手术结果为肩袖浅表部分撕裂;1例MRI表现正常,关节镜发现肱二头肌长头肌腱炎,其余11例手术所见与MRI表现基本一致,另21例经保守治疗,症状消失或好转。结论肩关节MRI能清晰显示出肩关节的复杂解剖结构,对慢性肩关节疼痛的病因诊断有较高的准确性,是一项有价值的检查方法。     

上颈段颈椎退变性颈肩痛临床诊治探讨

目的:探讨上颈段(C1～C4)颈椎退变性颈肩痛的临床特点并比较不同康复治疗方案的临床疗效.方法:将52例临床诊断为颈肩部肌肉筋膜炎的患者分为三组:上颈段颈椎退变1组(A组,16例),上颈段颈椎退变2组(B组,15例)和非上颈段颈椎退变组(C组,21例).三组均采用相同的推拿和中频电治疗.不同的是A组增加了颈椎牵引和针对根型颈椎病的手法治疗.3组的治疗时间均为2周,治疗次数均不超过10次.治疗前后进行VAS疼痛评分,并对各组疗效进行Odom评定.结果:三组之间性别、年龄和病程均无显著差异性.上颈段颈椎退变性颈肩痛的主要临床特点是伴随斜方肌张力升高和压痛的锁骨水平以上部位的颈肩部肌肉筋膜炎表现.治疗后A组和C组V.AS评分明显改善,均好于B组(P=0.000).Odom评定结果显示:A组治疗优良率(93.8%)和C组(95.2%)相比无显著性差异(P=0.692),均优于B组(P=0.001).结果提示:对于伴有斜方肌张力升高和压痛的颈肩部肌肉筋膜炎患者应常规摄颈椎X线片了解上颈段颈椎退变情况.对于伴随上颈段颈椎退变和上颈段椎间孔狭窄的患者,建议按神经根型颈椎病而不是单纯颈肩部肌肉筋膜炎的康复治疗方法进行治疗,可以取得良好的治疗效果.     

Posterior Shoulder Pain and Arthroscopic Decompression of the Suprascapular Nerve at the Spinoglenoid Notch

Suprascapular nerve compression is a disease entity not easily recognized or well understood by many surgeons. Posterior shoulder pain, muscle weakness, and muscle atrophy can result from compression of the nerve at either the transverse scapular ligament or the spinoglenoid ligament in many young adults. Compression at the spinoglenoid ligament, although thought to be rare, is often the result of repetitive overhead activities in either athletes or laborers and results in weakness and atrophy of the infraspinatus muscle. More recently, compression at this site occurs in patients with a massive rotator cuff tear. While this diagnosis is complex and other diagnoses must be considered and ruled out, early intervention is important to successfully manage this patient and return them to their desired activities to avoid permanent muscle atrophy. This paper will discuss the detailed physical examination, adjunct diagnostic procedures, and appropriate arthroscopic surgical treatment of this disease entity to provide the expected outcome with great satisfaction.     

Posterior Shoulder Pain and Arthroscopic Decompression of the Suprascapular Nerve at the Transverse Scapular Ligament

The etiology of posterior shoulder pain can be elusive for the treating physician. Compression of the suprascapular nerve at either the transverse scapular ligament or the spinoglenoid ligament can lead to resultant posterior shoulder pain, muscle weakness, and permanent muscle atrophy. Compression at the transverse scapular ligament, the more common finding than realized in the past in patients, can often result in weakness and atrophy of both the supraspinatus and infraspinatus muscles as compression occurs at the suprascapular notch prior to the nerve giving off motor branches to each of these muscles. Patients with this pathology often have a long-standing disease course of missed diagnoses and even wrong surgical procedures. This paper will discuss the anatomy, pathophysiology, and presentation of symptoms in patients. A thorough discussion of the physical examination as well as appropriate adjunct diagnostic procedures will follow to aid the clinician in making a correct diagnosis with detailed recommendations for appropriate arthroscopic decompression allowing the athlete and patient to return to activities of daily living with a short recuperation period.     

Transarterial Embolization of Neovascularity for Refractory Nighttime Shoulder Pain: A Multicenter,Open-Label,Feasibility Trial

PurposeTo assess the feasibility of transarterial embolization (TAE) for recalcitrant nighttime shoulder pain in a multicentric study.Materials and MethodsThis prospective, open-label, feasibility trial included 100 patients treated at 5 institutions. TAE was performed in 76 patients with adhesive capsulitis (AC) and 24 patients with symptomatic rotator cuff tears (sRCTs). The ipsilateral radial artery was punctured, and imipenem/cilastatin sodium was infused as an embolic agent. Adverse events, 10 point pain numerical rating scale (NRS), range of motion (ROM) of the shoulder joint, and quality of life (via the EuroQol-5D [EQ-5D]) were evaluated.ResultsAll patients exhibited neovascularity on baseline angiography, and all TAE procedures were performed successfully. No patient experienced a major adverse event. The mean nighttime pain NRS scores at baseline and 1, 3, and 6 months after TAE were 6.4 ± 2.2, 3.4 ± 2.6, 2.3 ± 2.5, and 1.6 ± 2.2, respectively (for all, P < .001). The mean ROM of anterior elevation at baseline and 1, 3, and 6 months after TAE were 97° ± 29°, 119° ± 28°, 135° ± 27°, and 151° ± 17°, respectively (for all, P < .001). The mean EQ-5D scores at baseline and 1, 3, and 6 months after TAE were 0.63 ± 0.17, 0.73 ± 0.16, 0.80 ± 0.17, and 0.84 ± 0.17, respectively (for all, P < .001). There was no significant difference in the clinical success rate between the AC and sRCT groups.ConclusionsTAE for nighttime shoulder pain caused by AC and sRCTs was feasible with sufficient safety and efficacy.     

急、慢性颈肩痛患者的远红外热像特征分析

目的 通过分析颈肩痛患者红外热像图的改变,为颈肩痛的临床诊断和治疗提供客观依据.方法 对照组健康体检者40例,颈肩痛组颈椎病34例和急、慢性颈肩软组织损伤6例.暴露检查部位,应用ATIR-M301B非制冷焦平面红外热像仪,采取全身及项背部远红外热图.应用本机提供的分析软件,分别比较同一受检者项部、背部、肩部等测温区左右两侧的温度差,并行统计学分析.结果 对照组受检者的项部、背部、肩部等测温区的远红外热像呈左右对称分布,脊柱中央呈高温区,项部、背部及肩部左右两侧温度均匀对称,两侧平均温差为0.07℃,差异无显著意义(P>0.05).颈肩痛组患者的远红外热图像呈左右不对称分布,出现明显的局部高温区或低温区.急性颈肩痛患者疼痛区局部温度明显高于周嗣组织,可达2℃以上;而慢性颈肩痛患者疼痛区局部的热像表现不一,大部分呈低温改变,少数患者疼痛部位呈高温改变.结论 远红外热像检查可反映出急、慢性期颈肩痛患者疼痛部位的温度变化,为临床诊治提供个体化依据.     

Shoulder arthroplasty

Shoulder prostheses are now commonly used. Clinical results and patient satisfaction are usually good. The most commonly used types are humeral hemiarthroplasty, unconstrained total shoulder arthroplasty, and semiconstrained inversed shoulder prosthesis. Complications of shoulder arthroplasty depend on the prosthesis type used. The most common complications are prosthetic loosening, glenohumeral instability, periprosthetic fracture, rotator cuff tears, nerve injury, infection, and deltoid muscle dysfunction. Standard radiographs are the basis of both pre- and postoperative imaging. Skeletal scintigraphy has a rather limited role because there is overlap between postoperative changes which may persist for up to 1 year and early loosening and infection. Sonography is most commonly used postoperatively in order to demonstrate complications (hematoma and abscess formation) but may also be useful for the demonstration of rotator cuff tears occurring during follow-up. CT is useful for the demonstration of bone details both pre- and postoperatively. MR imaging is mainly used preoperatively, for instance for demonstration of rotator cuff tears.     

Shoulder biomechanics

The biomechanics of the glenohumeral joint depend on the interaction of both static and dynamic-stabilizing structures. Static stabilizers include the bony anatomy, negative intra-articular pressure, the glenoid labrum, and the glenohumeral ligaments along with the joint capsule. The dynamic-stabilizing structures include the rotator cuff muscles and the other muscular structures surrounding the shoulder joint. The combined effect of these stabilizers is to support the multiple degrees of motion within the glenohumeral joint. The goal of this article is to review how these structures interact to provide optimal stability and how failure of some of these mechanisms can lead to shoulder joint pathology.