Objective To summarize mid-term effectiveness of modified arthroscopic suture button fixation Latarjet procedure for treatment of recurrent anterior shoulder dislocations. Methods Between January 2018 and October 2020, 30 patients with recurrent anterior shoulder dislocations were treated with modified arthroscopic suture button fixation Latarjet procedure. There were 19 males and 11 females with an average age of 27.3 years (range, 18-41 years). The shoulder dislocation occurred 3-7 times, with an average of 4.9 times. The time from the last dislocation to operation was 3-10 days, with an average of 4.1 days. Glenoid defects exceeded 20% in all cases. There were 27 cases of Hill-Sachs lesions. The joint pain and function were estimated by visual analogue scale (VAS) score, University of California, Los Angeles (UCLA) score, Rowe score, American Association for Shoulder and Elbow Surgery (ASES) score, Walch-Duplay score, and the range of external rotation at 0° and external rotation at 90° abduction of shoulder before operation and at 1 month, 6 months, and last follow-up. The X-ray film, CT scan and three-dimensional reconstruction were reviewed to observe the position, healing, and absorption of the coracoid graft, correction of glenoid defect, and joint degeneration.Results The operation time ranged from 51 to 79 minutes, with an average of 68.4 minutes. All incisions healed without complications such as nerve or blood vessel injury. All patients were followed up 36-60 months with an average of 44.6 months. The VAS score, UCLA score, Rowe score, ASES score, Walch-Duplay score, and the range of external rotation at 0° and external rotation at 90° abduction after operation significantly improved when compared with preoperative values (P<0.05). All indicators further improved with time, and the differences between different time points after operation were significant (P<0.05). Imaging review showed that the coracoid graft was located in the anteroinferior glenoid at 1 day after operation, and no occurrence of shoulder osteoarthritis was found during follow-up. The anatomical structure of the glenoid was normal, and no delayed healing or non-union of the coracoid graft occurred. At 20 months after operation, arthroscopic re-exploration was performed in 1 case due to fracutre caused by falling injury revealed the good shaping of the coracoid graft, smooth glenoid, and no bone resorption or osteoarthritis. ConclusionFor recurrent anterior shoulder dislocations, the modified arthroscopic suture button fixation Latarjet procedure can obtain good recovery of shoulder function and low incidence of complications and has a good mid-term effectiveness.
Objective To investigate the effectiveness of double EndoButton suture fixation Latarjet procedure in the treatment of shoulder anterior dislocation with glenoid bone defect caused by military training injuries.MethodsThe clinical data of 14 patients with anterior shoulder dislocation with glenoid bone defect due to military training injuries who met the selection criteria and admitted between August 2021 and December 2022 were retrospectively analyzed. All patients were male, the age ranged from 21 to 38 years, with an average of 26.8 years. The time from initial dislocation to operation was 6-15 months, with an average of 10.2 months. Anterior shoulder dislocation occurred 5-12 times, with an average of 8.2 times. All glenoid bone defects were more than 10%, including 5 cases of 10%-15%, 8 cases of 15%-20%, and 1 case of 24%. All patients were treated by double EndoButton suture fixation Latarjet procedure. The operation time and complications were recorded. The shoulder function and pain were evaluated by the American Association for Shoulder and Elbow Surgery (ASES) score, Rowe score, Instability Severity Index Score (ISIS), and visual analogue scale (VAS) score before and after operation. The range of motion of the shoulder was recorded, including forward flexion, 0° external rotation, and abduction 90° external rotation. The position, healing, and resorption of the bone mass were evaluated by three-dimensional CT of shoulder joint after operation. Results All patients successfully completed the operation, and the operation time was 100-150 minutes, with an average of 119.7 minutes. There was no complications such as infection, vascular and nerve injury. All patients were followed up 12-20 months, with an average of 15.6 months. During the follow-up, 4 patients had bone mass separation, absorption, and recurrent anterior dislocation, and the shoulder joint fear test was positive. Imaging of the remaining patients showed that the bone mass healed well, no anterior dislocation recurrence occurred, and the healing time was 3-7 months (mean, 4.7 months). At last follow-up, the range of motion, ASES score, Rowe score, ISIS score, and VAS score of the patients significantly improved when compared with those before operation (P<0.05). ConclusionThe effectiveness of double EndoButton suture fixation Latarjet procedure for the treatment of anterior shoulder dislocation with glenoid bone defect caused by military training injury is satisfactory.
Objective To evaluate the efficacy and safety of different site injection of compound betamethasone injection, ropivacaine and sodium hyaluronate for treatment of frozen shoulder at early stage. Methods A Total of 68 participants were included from May 2015 to May 2017 and randomly assigned to the glenohumeral joint and subacromial space group (IA+SA group, n=34) and glenohumeral joint group (IA group, n=34). In the IA+SA group, a solution of 1 mL corticosteroid, 6 mL ropivacaine, 2 mL sodium hyaluronate, and 8 mL normal saline were prepared and injected to glenohumeral joint, and a solution of 1 mL corticosteroid, 2 mL ropivacaine, 2 mL sodium hyaluronate, and 2 mL normal saline were injected to subacromial space. In the IA group, participants were given the same dose of drugs to the glenohumeral joint. The Visual Analogue Scale (VAS) score and Constant-Murley score were used to assess pain and function of shoulder respectively. The change of VAS score and Constant-Murley score after treatment were used to evaluate pain relief and shoulder function improvement. Results Of the 68 participants, two in each group were lost to follow up and one in the IA+SA group dropped out. There was significant effect on pain relief and shoulder function improvement on all measurement in both groups (P<0.001) during the 12 weeks after treatment. In the IA group, group- by-time interaction were significant for pain relief at 6 and 12 weeks comparing with that at 3 weeks (P<0.001), while no significant difference at 6 weeks comparing with 12 weeks. In the IA+SA group, group-by-time interaction were significant for pain relief at all endpoints (3 weeksvs. 6 weeks: P<0.001; 3 weeksvs. 12 weeks: P<0.001; 3 weeksvs. 6 weeks: P=0.034). In both groups, there was significant effect on shoulder function improvement when compared at each endpoint within group (P<0.001). Between-group comparison revealed no significant effect on pain relief (P=0.386) or shoulder function improvement (P=0.685). There was also no significant effect on pain relief (3 weeks: P=0.898; 6 weeks: P=0.448; 12 weeks: P=0.216) and shoulder function improvement (3 weeks: P=0.120; 6 weeks: P=0.152; 12 weeks: P=0.868) at each same endpoint. Conclusions Different site injection can effectively release pain and improve shoulder function for the patients with frozen shoulder at early stage and be well tolerated. However, it is not found that two site injection is inferior to single site injection.
ObjectiveTo review the research progress of the biomechanical study of the Bristow-Latarjet procedure for anterior shoulder dislocation. MethodsThe related biomechanical literature of Bristow-Latarjet procedure for anterior shoulder dislocation was extensively reviewed and summarized. ResultsThe current literature suggests that when performing Bristow-Latarjet procedure, care should be taken to fix the bone block edge flush with the glenoid in the sagittal plane in the direction where the rupture of the joint capsule occurs. If traditional screw fixation is used, a double-cortical screw fixation should be applied, while details such as screw material have less influence on the biomechanical characteristics. Cortical button fixation is slightly inferior to screws in terms of biomechanical performance. The most frequent site of postoperative bone resorption is the proximal-medial part of the bone block, and the cause of bone resorption at this site may be related to the stress shielding caused by the screw. ConclusionThere is no detailed standardized guidance for bone block fixation. The optimal clinical treatment plan for different degrees of injury, the factors influencing postoperative bone healing and remodeling, and the postoperative osteoarticular surface pressure still need to be further clarified by high-quality biomechanical studies.
ObjectiveTo investigate the effectiveness of open reduction and internal fixation for multiple injuries of superior shoulder suspensory complex (SSSC) with coracoid process fracture.MethodsBetween January 2014 and October 2018, 22 patients with multiple injuries of SSSC with coracoid process fracture were treated by open reduction and internal fixation. There were 16 males and 6 females, aged from 24 to 72 years with an average age of 36.6 years. There were 10 cases of falling injury, 5 cases of traffic accident injury, and 7 cases of falling from height injury. All of them were fresh closed injuries. The time from injury to operation ranged from 2 to 17 days with an average of 6.9 days. Both X-ray film and CT showed the coracoid process fracture complicated with clavicular fracture in 14 cases, acromioclavicular joint dislocation in 12 cases, and acromioclavicular fracture in 5 cases. There were 14 cases of two places of SSSC, 7 cases of three places of SSSC, and 1 case of four places of SSSC.ResultsAll incisions healed in primary stage after operation. All patients were followed up 10-24 months with an average of 14.1 months. X-ray films showed that all fractures healed and the acromioclavicular joint was normal. The healing time ranged from 6 to 12 months, with an average of 6.2 months. No complications such as internal fixation failure and nonunion occurred. According to University of California Los Angeles (UCLA) shoulder scoring system, the shoulder joint function was rated as excellent in 15 cases, good in 5 cases, and poor in 2 cases at last follow-up. The excellent and good rate was 90.9%.ConclusionOpen reduction and internal fixation for treatment of multiple injuries of SSSC with coracoid process fracture is firm and reliable. Combined with active postoperative rehabilitation program intervention, it can accelerate the recovery of shoulder joint function and achieve satisfactory effectiveness.
Objective To review the research progress of ultrasound in the diagnosis and treatment of shoulder diseases, in order to provide a theoretical basis for the further development of ultrasound in shoulder surgery. Methods The recent literature on the application of ultrasound in the shoulder joint was extensively reviewed. The application of ultrasound in the diagnosis and treatment of shoulder joint diseases, and the advantages and disadvantages of ultrasound were analysed, and the development trend of ultrasound technology in the shoulder joint area was prospected. Results At present, the diagnosis of shoulder joint diseases mainly relies on MRI, however, with the development of ultrasound technology, ultrasound with the characteristics of convenient, reliable, and real-time dynamic evaluation is more and more recognized in the diagnosis process of shoulder joint diseases, combined with three-dimensional ultrasound, ultrasound intervention, and elastography can improve the accuracy, sensitivity, and specificity of the diagnosis, and is suitable for the diagnosis and treatment of various shoulder joint diseases, which is expected to carry out early prevention of shoulder joint diseases in the future and achieve more refined and minimally invasive treatment. ConclusionUltrasound technology has wide application prospect in shoulder joint diseases, but it is still in the developing stage, and the subjective dependence needs to be solved further.
Frozen shoulder is a common disease in orthopaedic clinic. The main clinical manifestations were shoulder joint pain and limited active and passive activity. However, the etiology and pathogenesis of frozen shoulder are not fully understood, so people can not choose the appropriate treatment plan. In recent years, there have been a lot of exploration on the pathogenesis and treatment measures of this disease at home and abroad, but there is no unified standard for the treatment of frozen shoulder. This article summarizes the treatment methods of frozen shoulder at home and abroad in recent years, analyzes the advantages and disadvantages of non-surgical treatment and surgical treatment, in order to provide assistance for clinical practice.
Objective To evaluate the early-term effectiveness of Latarjet procedure with double EndoButtons fixation for recurrent anterior shoulder dislocation by coracoid osteotomy with preserving coracoacromial ligament. Methods Between January 2021 and June 2023, 19 patients with recurrent anterior shoulder dislocations were treated by arthroscopic Latarjet procedure with double EndoButtons fixation, all of which underwent coracoid osteotomy with preserving the coracoacromial ligament. There were 11 males and 8 females, with an average age of 23.3 years (range, 17-32 years). Shoulder dislocations ranged from 3 to 11 times, with an average of 6.4 times. The disease duration ranged from 3 to 35 months, with an average of 12.9 months. All apprehension tests were positive. Imaging examination showed that the defect width of the ipsilateral glenoid bone was 13%-26%, with an average of 19.8%. After operation, the shoulder range of motion was examined, including flexion lift, lateral external rotation, extension 90° external rotation, and internal rotation. Shoulder joint function was evaluated by Walch-Duplay score, American Association for Shoulder and Elbow Surgery (ASES) score, and Rowe score. Imaging examinations were taken to observe the position and shaping of coracoid. Results All incisions healed by first intention and no nerve or vessel injury occurred. All patients were followed up 9-24 months (mean, 14.5 months). There was no recurrence of shoulder dislocation and the apprehension tests were negative during follow-up. There was no significant difference in the shoulder range of motion (flexion lift, lateral external rotation, extension 90° external rotation, and internal rotation) between preoperation and at last follow-up (P>0.05). The Walch-Duplay score, ASES score, and Rowe score significantly improved when compared with those before operation (P<0.05). Postoperative imaging showed that coracoid graft was at the same level with the glenoid in all cases; the center of coracoid graft was located between 3 to 5 o’clock. During follow-up, there was no glenohumeral joint degeneration, the acromiaohumeral distance was not reduced when compared with preoperation, and the coracoid bone gradually formed concentric circles with the humeral head. Conclusion The Latarjet procedure with double EndoButtons fixation can effectively treat recurrent anterior shoulder dislocation by coracoid osteotomy with preserving coracoacromial ligament, and the early-term effectiveness is satisfactory.
Objective To observe the effect of extracorporeal shock wave therapy combined with conventional rehabilitation in the treatment of hemiplegic shoulder pain (HSP). Methods HSP patients admitted to Huadong Hospital Affiliated to Fudan University between January and October 2022 were selected. The enrolled patients were randomized into a control group and an experimental group in a 1∶1 ratio using SPSS 26.0 statistical software. The control group was given conventional rehabilitation training, and the experimental group was given extracorporeal shock wave treatment on this basis. Both groups were treated for 4 weeks. Primary outcome measure was Visual Analogue Scale (VAS) for pain. Secondary outcome measures were passive range of motion (PROM) of the shoulder joint, Fugl-Meyer Assessment of Upper Extremity (FMA-UE), and the activities of daily living were assessed by Modified Barthel Index (MBI). Results A total of 39 patients were included. Among them, there were 19 cases in the experimental group and 20 cases in the control group. Before treatment, there was no statistically significant difference in VAS, FMA-UE, MBI scores, and the PROM of flexion, extension, abduction, external rotation and internal rotation between the two groups (P>0.05). After treatment, there was no statistically significant difference in MBI score and the PROM of extension, abduction, external rotation, internal rotation between the two groups (P>0.05). After treatment, intra group comparisons showed that the VAS, FMA-UE, MBI scores, and the PROM of flexion, extension, abduction, external rotation, and internal rotation of the two groups were better than before treatment (P<0.001). After treatment, inter group comparison showed that the the VAS score in the experimental group was lower than that in the control group (t=5.291, P<0.05), while the FMA-UE score and the PROM of flexion in the experimental group were higher than those in the control group (t=−4.008, 3.164, P<0.05). Conclusion Extracorporeal shock wave therapy can significantly reduce the pain degree of patients with HSP and improve upper limb function and activities of daily living.
ObjectivesTo systematically review the epidemiological characteristics of post-stroke shoulder pain (PSSP).MethodsPubMed, WanFang Data, CNKI, EMbase, The Cochrane Library and SinoMed databases were electronically searched to collect studies on the morbidity of PSSP from inception to November 30th, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 15.0 software.ResultsA total of 13 studies were included. The total sample size was 3 514, including 1 357 patients with PSSP. The results of meta-analysis showed that the total morbidity of PSSP was 45.0% with 95%CI 32.0% to 58.0%. The results of subgroup analysis showed that the morbidity of PSSP was 55.5% (95%CI 48.1% to 63.0%) prior to 2010 and 40.6% (95%CI 28.3% to 52.9%) after 2010, respectively. The morbidity of PSSP in Asia was 61.2% (95%CI 51.3% to 71.1%), and in Europe and America was 18.4% (95%CI 9.9% to 26.9%), respectively.ConclusionsCurrent evidence suggests that PSSP has high morbidity, and it may be affected by regional factors. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.