Mid-term results following arthroscopic capsular release in patients with primary and secondary adhesive shoulder capsulitis

Purpose

The purpose of this study was to assess the effectiveness of arthroscopic capsular release carried out for refractory cases of both primary and secondary adhesive shoulder capsulitis that were not responsive to at least 6 months of prior conservative therapy.

Methods

Arthroscopic 360-degree capsular release was performed on 167 patients (173 shoulders) with adhesive shoulder capsulitis. Ninety-one shoulders (52.6 %) had primary and 82 shoulders (47.4 %) secondary adhesive capsulitis. The median follow-up period was 36 months (range 14–67 months).

Results

All patients were evaluated according to the constant score. Both groups (primary and secondary adhesive capsulitis) experienced a significant improvement for all ranges of motion immediately postoperative, as well as at the time of follow-up. The median preoperative constant score was 41 (range 18–61) points and increased significantly to a median of 83 (range 27–100) at the time of follow-up. In the group of primary adhesive capsulitis, median preoperative score was 42 points (range 19–58) and increased to 85 points (range 36–100) at follow-up. In the group of secondary adhesive capsulitis, the preoperative mean increased from 41 points (range 18–61) to 74 points (range 27–100) at the time of the follow-up. The constant score component for pain and the visual analogue scale (VAS) score were also significantly increased.

Conclusion

Arthroscopic capsular release in patients with primary and secondary adhesive shoulder capsulitis represents a valuable therapeutic choice with minimal complications, to effectively reduce pain and improve movement in all planes of motion.

Level of evidence

Therapeutic retrospective case series study, Level IV.     

Adhesive capsulitis: sonographic changes in the rotator cuff interval with arthroscopic correlation

Objective To evaluate the sonographic findings of the rotator interval in patients with clinical evidence of adhesive capsulitis immediately prior to arthroscopy.Design and patients We prospectively compared 30 patients with clinically diagnosed adhesive capsulitis (20 females, 10 males, mean age 50 years) with a control population of 10 normal volunteers and 100 patients with a clinical suspicion of rotator cuff tears. Grey-scale and colour Doppler sonography of the rotator interval were used.Results Twenty-six patients (87%) demonstrated hypoechoic echotexture and increased vascularity within the rotator interval, all of whom had had symptoms for less than 1 year. Three patients had hypoechoic echotexture but no increase in vascularity, and one patient had a normal sonographic appearance. All patients were shown to have fibrovascular inflammatory soft-tissue changes in the rotator interval at arthroscopy commensurate with adhesive capsulitis. None of the volunteers or the patients with a clinical diagnosis of rotator cuff tear showed such changes.Conclusions Sonography can provide an early accurate diagnosis of adhesive capsulitis by assessing the rotator interval for hypoechoic vascular soft tissue.     

Full arthroscopic lateral retinacular release with hook knife and quadriceps pressure-pull test: long-term follow-up

The most important causes of anterior knee pain include patellofemoral malalignment which causes patella–condyle contact anomalies at the patellofemoral joint, excessive patellar lateral pressure increase, trauma and overuse. In this article, besides presentation of late clinical results of 169 lateral retinacular release cases which were surgically treated between January 1995 and December 2002 with the help of a hook knife from the anterolateral portal due to lateral compression syndrome and patellar maltracking, we also described quadriceps tendon pressure-pull test which strongly indicates patellofemoral pain during physical examination of a patient with anterior knee pain. In addition to radiological patellofemoral imaging methods, we describe dynamic arthroscopic patellofemoral joint examination which is applied perarthroscopically to all of our surgically treated patients. We divided the patients into two groups: group 1 was the younger group with age 16–40 years; group 2 was the older group with age >41 years. Preoperative mean Lysholm scores for group I was 67.6 and 98.6, postoperatively, whereas it was 62.3 preoperatively and 91.4 postoperatively in group 2. This improvement of Lysholm scores postoperatively was statistically significant for each of the two groups (p=0.001). For group 1 preoperative IKDC scores were A in 8 patients, B in 61 patients and C in 11 patients, whereas it was A in 78 patients and B in 2 patients postoperatively. For group 2 preoperative IKDC scores were A in 2 patients, B in 43 patients, C in 36 patients and D in 8 patients, whereas it was A in 78 patients and B in 11 patients. This improvement of IKDC scores postoperatively was also statistically significant for each of the two groups (p=0.001). Preoperative and postoperative congruens angles of all patients were also measured. Preoperative mean congruens angle was +16.4 in group 1 while mean congruent angle was –7.1 postoperatively. For group 2 preoperative mean congruens angle was +18.7 preoperatively and –6.9 postoperatively. This improvement was statistically significant for each of the two groups (p=0.001). The overall number of patellar lateral compression syndrome cases were 51 (24 in group 1, 27 in group 2), patellar lateralization cases were 64 (28 in group 1, 36 in group 2) and patellar subluxation cases were 54 (28 in group 1, 26 in group 2). At the evaluation of arthroscopic lateral patellar facet and lateral femoral condylar chondral pathologies, we statistically showed that patellar chondral pathologies were more severe than the femoral chondral pathologies (p=0.001). In our opinion, the severity of patellar lateral facet chondral lesions, although it has a thicker layer of cartilage, is due to distribution of load to a larger contact area of lateral femoral condyle [1, 2]. Statistically increasing severity of femoral (Kendalls tau-b: 0.248, p=0.001) and patellar chondral lesions (Kendalls tau-b: 0.444, p=0.0001) with age is compatible with our arthroscopic and clinical observations. The most important complication seen in our cases was fibrosis at the site of lateral release, seen in three patients. They were healed without any sequela with local corticosteroid injection into the fibrosis tissue. We did not see any hemarthrosis or haematoma as a complication.     

MRI of adhesive capsulitis of the shoulder: Distension of the bursa in the superior subscapularis recess is a suggestive sign of the pathology

Objective

To evaluate the diagnostic values of the superior subscapularis recess sign in patients with shoulder adhesive capsulitis. The sign consists in evaluating in MRI of the shoulder the presence of fluid distension of the bursa in the superior subscapularis recess.

Materials and methods

We evaluated MRI of 165 shoulders in 48 consecutive patients with a diagnosis of shoulder adhesive capsulitis in the freezing phase (group I), in 49 short-wide superior cuff tear (group II) and in 65 controls (group III) between 2010 and 2013. On the T2 weighted images, we evaluated the presence of an high intensity signal within the superior subscapularis recess, consistent with fluid distension of the bursa.

Results

The sign was found in 43/48 patients (89.58%) with shoulder adhesive capsulitis in 3/49 (6.12%) patients with superior cuff tear and in 1/65 controls (1.53%) (p < 0.001). The mean diagnostic values were: sensibility 0.91; specificity 0.96–0.98; positive predictive value 0.93–0.97; negative predictive value 0.92–0.94; likelihood ratios for an abnormal test result 15.16–60.6; likelihood ratios for a normal test result 0.086–0.095.

Conclusion

For the orthopedic surgeon or the clinician, the sign is useful to confirm in MRI the clinical diagnosis of shoulder adhesive capsulitis; accordingly, the radiologist should describe and relate this sign to the pathology in the report, looking eventually for further typical sign of shoulder adhesive capsulitis.     

360° arthroscopic capsular release in patients with adhesive capsulitis of the glenohumeral joint – indication, surgical technique, results

Adhesive capsulitis of the glenohumeral joint is said to be a self-limiting process. However, in some patients the disease can last much longer than 1 year, which may lead patients to more invasive treatment than merely undergoing physiotherapy. Other patients do not accept this severe limitation and choose treatment options that restore the range of motion (ROM) more rapidly. Conventional open release techniques generally improve motion but involve extensive dissection. The purpose of this study was to develop a safe and reproducible technique of arthroscopic capsular release (ACR) and to present the results of this technique in the clinical situation. The technique for ACR was first defined in a cadaver study and then applied in 28 patients with primary adhesive capsulitis of the glenohumeral joint. The patients were selected for the arthroscopic release when conservative therapy had failed for at least 6 months. All of the patients had a global loss of shoulder motion and had motion restored with a combined anterior, posterior, superior, and inferior release of the of the capsule (360 degrees release). Additionally, in all patients synovectomy with electrocautery was performed. We documented the ROM in the different planes as well as the Constant score. The Constant score improved a mean of 41 points. Range of motion for all planes significantly improved (P < 0.01). Abduction improved from 75 degrees preoperatively to 165 degrees intraoperatively; 6 weeks after surgery, mean abduction was 168 degrees and at the time of follow-up it was 167 degrees. Mean external rotation in adduction improved from 3 degrees preoperatively to 75 degrees intraoperatively. After 6 weeks, the mean external rotation in adduction was 72 degrees and at the time of follow-up the external rotation reached 76 degrees. Mean external rotation in abduction improved from 4 degrees preoperatively to 81 degrees intraoperatively, 80 degrees after 6 weeks and 85 degrees at the time of the last follow-up. Internal rotation in abduction was 17 degrees preoperatively. Intraoperatively, mean internal rotation was 59 degrees. An angle of 58 degrees was documented at 6 weeks follow-up, and at the last follow-up an angle of 63 degrees was documented. No postoperative lesion of the axillary nerve was present. We concluded that arthroscopic capsular release is a reliable method for restoring motion with minimum morbidity in carefully selected patients. When performing an ACR the incision of the glenohumeral joint capsule should be undertaken at the glenoidal insertion in the abducted and external rotated shoulder.     

Which joint position puts the axillary nerve at lowest risk when performing arthroscopic capsular release in patients with adhesive capsulitis of the shoulder?

The success of arthroscopic capsular release of the glenohumeral joint depends on complete incision of the inferior capsule. This study determined the distance between capsule and the axillary nerve in different joint positions. In 14 human shoulder specimens the anterior joint capsule and axillary nerve were dissected, and the anterior joint capsule was incised between the 1 and 5 o'clock positions. The shortest distance between the insertion of the inferior capsule and the axillary nerve was measured at the glenoid and humeral insertions in abduction, adduction, internal, and external rotation. The axillary nerve is surrounded from soft connective tissue and is closer to the humeral than to the glenoidal attachment of the joint capsule. During abduction and external rotation the nerve stays in its position while the glenohumeral capsule tightens, which increases the distance between the two structures. This results in the following distances: to the glenoidal/humeral capsule insertion: in adduction and neutral rotation, 21.2+/-4.2/14.2+/-2.6 mm; in abduction and neutral rotation, 24.0+/-4.9/15.0+/-5.0 mm; in abduction and internal rotation, 21.1+/-6.6/14.6+/-3.7 mm; and in abduction and external rotation, 24.9+/-3.8/16.4+/-4.4 mm. Thus, when performing arthroscopic capsular release the incision of the glenohumeral joint capsule should be undertaken at the glenoidal insertion in the abducted and externally rotated shoulder.     

美军健康相关状况及干预措施研究的系统评价

目的：系统评价美军健康相关状况及干预措施,为我军健康促进策略的制定提供借鉴。方法计算机检索PubMed、Medline、Springer、Elservier、HighWire和CNKI等数据库,利用设定的检索策略检索1997年1月～2015年12月发表的关于美军健康相关状况及干预策略或措施的文献。结果经筛选后最终纳入25篇文献,包含训练伤、腰腿痛、创伤后应激障碍、抑郁症、心血管疾病等方面。结论美军主要的健康问题及其所关注的干预策略或措施包括训练伤、腰腿痛、心理疾病和心血管疾病等4个方面,对军人的健康保障正在从单一的疾病预防走向多元化的全面维护,以实现新时期部队的整体强健。     

发展我军指战员健康信息技术

指战员的生理、心理健康是战斗力的重要组成部分。本文着重分析了现代高技术战争与指战员生理、心理健康状态之间的密切关系,阐述了发展我军指战员健康状态信息技术的必要性和主要技术内容。这些技术包括低生理、心理负荷的生命基本信息获得技术,健康信息通讯网络技术,信息挖掘与融合技术,以及信息保存技术等。通过上述安全的低生理、心理负荷检测技术,获得指战员完全自然状态下的生理和心理信息,更好地保障指战员的健康和现代军事训练的安全。     

在校本科生失眠症患者心理健康状况及人格特征

目的:研究患失眠症在校本科生的心理健康状况及人格特征.方法:采用症状自评量表(SCL-90)、艾森克成人个性问卷(EPQ)、卡特尔十六人格因素量表(16PF)分别对54名患失眠症在校本科生和55名健康在校本科生作对照研究.结果:SCL-90中总均分及阳性项目数、躯体化等因子分研究组高于对照组(P＜0.05);EPQ及16PF显示研究组在情绪稳定性、低敢为H、高敏感I、高怀疑L、高幻想M、高忧虑O存在差异(P＜0.05).结论:患失眠症的在校本科生存在一定的心理问题,其个性心理特征也较为一致,失眠的发生与个体素质呈现相关.     

武警部队医院体检与健康管理机构现状调查

 目的 了解武警部队医院体检与健康管理机构的一般状况、业务内容、运营情况,以及面临的主要问题和需求等信息,为武警部队体检与健康管理机构的建设与发展提供科学依据。方法 2014-10采用自行设计的问卷对武警部队开展体检与健康管理业务的45个总队医院和机动部队医院进行调查。调查方式采用现场问卷和电子邮件发放的方式进行。根据问卷调查的结果,选择部分机构进行深入访谈。对调查对象的基本状况、业务内容、运营状况、发展问题及需求等情况进行描述。结果 调查对象中,三级单位有25个,二级或二级以下的单位有20个,平均占地面积为(854±129)m²。25个机构设备总值超过200万元(55.6%)。31个机构配备了健康体检软件(68.9%),配备健康管理软件的有14个机构(31.1%)。33个机构配备了专职的健康体检工作人员(73.3%)。结论 武警部队医院体检与健康管理机构发展迅速,机构总规模逐年扩大,软件设备逐年提高,但仍然存在财力投入不足、专业人才缺乏、技术来源渠道不畅通、政策支持力度不够等问题。
     

青年卒中患者心理健康状况及其影响因素研究

目的调查青年卒中患者心理健康状况及其影响因素,为制定预防保健措施提供科学依据。方法采用随机抽样的方法,利用一般资料表、症状自评量表、社会支持量表以及家庭功能量表对120例青年卒中患者进行问卷调查。结果青年卒中患者心理异常阳性检出率为49.17%（59例）;与1986年、2006年全国常模比较,青年卒中患者症状自评量表总分及各因子得分均较高（P＜0.05）;多元逐步回归分析显示,文化程度、家庭功能、社会支持3个变量是青年卒中患者心理健康主要影响因素。结论青年卒中患者心理健康状况较差,医护人员应当及时采取有效干预措施,改善患者心理健康水平。     

SARS治疗一线医护人员心理健康状况调查

目的研究SARS治疗一线医护人员在工作不同阶段的心理健康状况。方法采用症状自评量表(SCL90)对小汤山医院620名一线医护人员进行心理评估。结果除精神病性因子以外,该群体SCL90各因子5个时间段的得分与地方常模比较,差异均有统计学意义(P<0.05);每个因子5个时间段的得分之间的比较差异有统计学意义(P<0.05)。各因子不同时间段的得分呈动态变化,焦虑、恐怖因子得分逐步下降,躯体化、强迫、抑郁、偏执因子得分先升高后下降,人际敏感因子得分先下降后上升,敌对因子得分最后有所升高。结论SARS治疗一线医护人员的心理健康水平总体上低于地方常模,焦虑、恐怖、强迫、躯体化症状相对突出,其心理健康状况值得重视。     

高原边防驻营区及野外驻训部队军人体格健康状况的研究

目的 调查高原低氧环境对军人身体指标的影响,以及高原驻训期间军人体格指标的变化,为保障人员体格强健提供参考依据.方法 根据《军队营养调查与评价方法》(GJB 1636A-2016)和《中国人民解放军战士身体发育测量及评价》(GJB 1102-91)的方法对驻高原4000~4600 m营区及4300 m野外驻训部队官兵进行体格指标的检测,并根据标准对相关结果进行评价.结果 与10年前阿里地区驻训部队人员指标相比,其BMI、上臂肌围、皮褶厚度、体脂含量均增加且接近平原值.4000和4600 m海拔两个单位人员的体格指标无显著差异.野外驻训部队人员上臂肌围显著高于驻营区部队,且BMI、皮褶厚度和体脂含量显著低于驻营区部队.与驻营区部队相比,驻训部队BMI和上臂肌围的构成比无显著差异,而体脂含量偏低的人员比例显著高于驻营区部队,体脂含量正常和偏胖人员比例显著低于驻营区部队.结论 驻高原地区军人体格指标不受海拔影响,而随着营养膳食保障力量的提高,军人身体指标得到改善,体内蛋白质和脂肪储备增加.野外驻训部队与驻营区部队军人相比,其肌肉含量更高,体脂更低,体格更健硕.     

Shoulder adhesive capsulitis in cancer patients undergoing positron emission tomography - computed tomography and the association with shoulder pain

BACKGROUNDAdhesive capsulitis is a relatively common condition that can develop in cancer patients during treatment. Positron emission tomography - computed tomography (PET-CT) is routinely performed as a follow-up study in cancer patients after therapy. Being aware of PET-CT findings to suggest shoulder adhesive capsulitis may help to alert clinicians for the diagnosis of unsuspected shoulder capsulitis.AIMTo assess the association of shoulder adhesive capsulitis with cancer/therapy type and symptoms in cancer patients undergoing PET-CT.METHODSOur prospective study received Institutional Review Board approval. Written informed consent was obtained from all patients, who answered a questionnaire regarding shoulder pain/stiffness at the time of PET-CT study, between March 2015 and April 2019. Patients with advanced glenohumeral arthrosis, metastatic disease or other mass in the shoulder, or shoulder arthroplasty were excluded. Patterns of shoulder capsule 18F-fluorodeoxyglucose (FDG) uptake were noted. Standard Uptake Value (SUV)max and SUVmean values were measured at rotator interval (RI) and deltoid muscle in bilateral shoulders. Normalized SUV (SUV of RI/SUV of deltoid muscle) was also calculated. We assessed if SUV values are different between symptomatic and asymptomatic patients in both shoulders. Covariates were age, gender, and therapy type (surgery, chemotherapy, radiation). Wilcoxon rank sum tests were used to compare unadjusted marginal differences for age, SUV measurements between symptomatic and asymptomatic patients. Multiple linear regression models were used to examine the relationship between right or left shoulder SUV measurements and symptom status, after adjusting for covariates. Statistical significance level was set at P < 0.05.RESULTSOf 252 patients initially enrolled for the study (mean age 66 years, 67 symptomatic), shoulder PET-CT data were obtained in 200 patients (52 were excluded due to exclusion criteria above). The most common cancer types were lymphoma (n = 61), lung (n = 54) and breast (n = 53). No significant difference was noted between symptomatic and asymptomatic patients in terms of age, gender, proportion of patients who had surgical therapy and radiation therapy. A proportion of patients who received chemotherapy was higher in patients who were asymptomatic in the right shoulder compared to those symptomatic in the right shoulder (65% vs 48%, P = 0.012). No such difference was seen for the left shoulder. In both shoulders, SUVmax and SUVmean were higher in symptomatic shoulders than asymptomatic shoulders (Left SUVmax 2.0 vs 1.6, SUVmean 1.6 vs 1.3, both P < 0.002; Right SUVmax 2.2 vs 1.8, SUVmean 1.8 vs 1.5, both P < 0.01). For lung cancer patients, bilateral RI SUVmax and SUVmean values were higher in symptomatic shoulders than asymptomatic shoulders. For other cancer patients, symptomatic patients had higher left RI SUVmax/mean than asymptomatic patients after adjustment.CONCLUSIONIn symptomatic patients metabolic activities in RI were higher than asymptomatic patients. Adhesive capsulitis should be considered in cancer patients with shoulder symptoms and positive FDG uptake in RI.     

武警官兵健康状况调查分析与评估

  目的 了解武警部队官兵的健康状况,为有针对性地开展健康教育提供理论依据。方法 分别选取南方、北方地区武警某部官兵255名和138名,共393名。采用自测健康评定量表,了解官兵的生理健康、社会健康及精神健康状况。结果 不同地区、不同年龄及不同入伍时间的武警官兵自测健康情况存在统计学差异(P＜0.05)。南方地区组的总体健康评分(360.01±52.16)高于北方地区评分(335.35±46.56),差异有统计学意义(P＜0.05);18~25岁年龄组的总体健康评分(356.05±51.16)高于26~34岁年龄组评分(334.07±49.68),差异有统计学意义(P＜0.05);入伍时间在2001—2011年的健康评分(337.66±44.13)高于入伍时间在2012—2017年组的评分(357.15±53.43),差异有统计学意义(P＜0.05)。结论 武警官兵的总体健康良好,但不同地区、不同年龄及不同入伍时间的武警官兵健康状况不同。     

某舰艇部队士兵心理健康状况及其影响因素

目的探讨舰艇部队士兵心理健康状况及其影响因素。方法采用艾森克个性问卷（EPQ）、简易应对方式问卷、症状自评量表（SCL-90），对某海军舰艇部队120名士兵进行现场调查。结果神经质是影响心理健康的人格因素之一，对心理健康有直接作用；内外向、精神质对心理健康的影响具有间接作用，积极应对方式是人格特征影响心理健康的中间环节。结论某海军舰艇部队士兵心理健康受人格特征与应对方式的影响。     

我国放射卫生信息化建设现状与展望

自2009年国家个人剂量登记系统应用以来，我国放射卫生信息化建设已走过10个年头，建立了全国放射卫生信息平台，涵盖个人剂量、职业性放射性疾病与职业健康、医用辐射防护、食品放射性核素监测、职业性放射性疾病报告5个系统，截至2018年，采集监测数据800余万条，平台授权用户1 400余名。本文就10年来我国放射卫生信息化建设的现状进行分析与总结，探讨放射卫生信息化发展的重点和难点，提出建议等，以期推进放射卫生信息化建设工作，更好地为职业性放射性疾病的预防与控制服务，助力"健康中国"建设。     

维持性血液透析患者营养状况与死亡风险的相关性探讨

 目的 探讨维持性血液透析患者营养状况与死亡风险的相关性。方法 选择北京积水潭医院2015-07至2018-12行维持性血液透析的95例患者进行营养评估,包括营养不良-炎症评分(malnutrition inflammation score,MIS)、改良主观综合评估法(modified quantitative subjective global assessment,MQSGA)和全球领导人发起的营养不良评估(global leadership initiative on malnutrition,GLIM)三种评估方法,同时收集患者基本资料及相关检查结果。随访41个月,采用Kappa检验、Kaplan-Meier以及COX回归分析比较不同营养评估方法与患者全因死亡风险的相关性。结果 (1) 95例中,男50例,女45例,平均(60±13.8)岁,随访中19例死亡,7例失访。(2)MQSGA与MIS两种评分法的一致性较好(Kappa=0.776),GLIM法与MQSGA(Kappa=0.381)及MIS(Kappa=0.311)的一致性不够理想。(3)Kaplan-Meier分析提示,以MIS及MQSGA评分作为分组标准,营养不良组患者的中位生存时间(33个月,37个月)均明显短于营养良好组(41个月,41个月),差异有统计学意义(P<0.001)。(4)多因素COX回归分析提示,在校正透析时间、血红蛋白、瘦组织指数、脂肪组织指数及容量负荷后,MIS 评分对血液透析患者死亡的预测效果最佳(HR=3.768,P=0.003)。结论 三种营养评估方法均可用于对血液透析患者进行营养评估,其中MIS法有助于预测患者的长期生存情况。