Objective To evaluate the clinical importance of doublecontrast CTdiagnosis of traumatic anterior shoulder instability. Methods Forty-eight patients underwent double contrast CT scan. With the guide of CT scan, anterior arthrocentesis of the shoulder was performed and 4 ml of 76% urografin was injected into the joint and then 10 ml of filtrated air was injected. The patients wereexamined by SOMATOM CR Systematic CT. The results of double contrast CT of the 48 patients were divided into Ⅰ, Ⅱ and Ⅲ degree according to the CT results related to their injury history, clinical symptoms, signs and operation findings. Results The patients had no complaint after the CT examination exceptfor 3 patients, who had slight pain within 2 days after CT examination. The results of double contrast CT were as follow:Ⅰ degree: 9 patients, Ⅱ degree: 22 patients, and Ⅲ degree: 17 patients. All patients with Ⅰ degree injuries were treated with rehabilitation program. The patients with Ⅱ degree injuries were mainly treated withrehabilitation program, but took much longer time. The patients with Ⅲ degreeinjuries were suggested to be treated with surgery. Conclusion To divide the results of double contrast CT into Ⅰ，Ⅱ and Ⅲ degree not only reflects the severity of traumatic anterior shoulder instability but provides information for the treatment of the instability.
OBJECTIVE: To study the reconstructional method and effect of shoulder joint function in the older obstetrical palsy with medial rotation contracture deformity. METHODS: From April 1996 to July 1999, 7 patients of older obstetrical palsy were adopted in this study. Among them, there were 5 males and 2 females, aged from 13 to 21 years old. No previous operation history and the main deformity was medial rotation contracture of shoulder. During operation, these patients were treated with "Z"-shape elongation of the tendon of subscapular muscle, transfer of the tendons of latissimus dorsi and teres major muscle to the tendons of supraspinous and infraspinous muscles. RESULTS: Followed up for 6 to 44 months(averaged 19 months), the Gilbert grading and Mallet scoring were 1.57, 7.57 preoperatively versus 3.45, 10.86 postoperatively, the abduction and external rotation of the shoulder joints recovered obviously. CONCLUSION: It is an effective operation for the older obstetrical palsy with medial rotation contracture of shoulder.
Objective To estimate the clinical curative effect of replacement of inverttype artificial total scapula and shoulder joint prosthesis and reserving arm with rehabilitation of function in the treatment of malignant tumor in shoulder. Methods From February 2001 and November 2004, five youth patients with primary malignant shoulder tumors were treated operatively by resection of neoplasmsthoroughly, replacement of inverttype artificial total shoulder blade and joint prosthesis, the functional reconstruction. Of them, there were 4 males and 1 female, aging from 19 to 26 years with an average of 23.6 years. Two cases were diagnosed as having osteosarcoma, one as having chondrosarcoma, and 2 as having Ewing sarcoma. After operation, the upper limbs was immobilized for 3 weeks. The rehabilitation training including passive exercise and initiative exercise. Results The average operative time was 425 min (380 to 530 min), and the blood loss ranged from 1 250 ml to1 900 ml(1 540 ml on average). The follow-up ranged from 7 to52 onths,with an average of 24.6 months. Postoperative complication included 1 case of pneumothorax, one case of shoulder incision skin part necrosis and 1 case of clavicle stump raising and pierce skin with shallow infection. No complication of postoperative incision deeply infection, nerve damage and prosthesis exposure or dislocation occurred. According to the scoring system of JOA(Japan orthopaedics association), the average score was 65 (60 to 72). The flexion and extension function of elbow joint recovered to normal. Conclusion The replacement of inverttype artificial total scapula and shoulder joint prosthesis is an efficacious method for the treatment of malignant tumor in shoulder. There are advantages of numerous adaption, wide range of motion and goodstability. It can not only reserve arm but also rehabilitate function.
ObjectiveTo investigate the cl inical characteristics of Eyres type V coracoid fracture combined with superior shoulder suspensory complex (SSSC) injuries, and the effectiveness of open reduction and fixation. MethodsBetween March 2004 and July 2012, 13 patients with Eyres type V coracoid fracture and SSSC injuries were treated. There were 10 males and 3 females with an average age of 41 years (range, 23-59 years). Injury was caused by fall ing from height in 4 cases, by traffic accident in 6 cases, and by impact of the heavy weight in 3 cases. The interval from injury to operation was 3-10 days (mean, 5.2 days). SSSC injuries included 9 cases of acromioclavicular joint dislocation, 5 cases of clavicular fractures, and 4 cases of acromion fractures. The coracoid fractures were fixed with cannulated screws; the acromioclavicular joint dislocations were fixed with hook plate (6 cases) or Kirschner wires (2 case) except 1 untreated case; the clavicular fractures were fixed with anatomical locking plate (3 cases) and hook plate (2 cases); the acromion fractures were fixed with cannulated screws (1 case), Kirschner wires (2 cases), or both of them (1 case). ResultsThe mean operation time was 158.0 minutes (range, 100-270 minutes), and the mean intraoperative blood loss was 207.7 mL (range, 150-300 mL). The other patients obtained primary healing of incision except 1 patient who had inflammation around incision, which was cured after change dressing. All patients were followed up for 22.6 months on average (range, 17-35 months). All fractures achieved union at a mean time of 3.6 months (range, 2-6 months). No nerve injury and implant fixation failure complications were observed. At last follow-up, the Constant score and the disabil ity of the arm, shoulder, and hand (DASH) score had a significant improvement when compared with scores at pre-operation (P<0.05). The shoulder range of motion in flexion, abduction, and external rotation at last follow-up were significantly higher than those at pre-operation (P<0.05). ConclusionEyres type V coracoid fracture associated with SSSC injuries usually results in the instabil ity of the shoulder. With individual surgical treatment, the satisfactory function and good effectiveness can be obtained.
Objective To review the recent research progress on shoulder arthroplasty, and to predict future research direction. Methods Recent l iterature concerned the shoulder arthroplasty was reviewed and analyzed in terms of appl iedanatomy, designs of prosthesis, patterns of prosthesis and fixation ways of prosthesis. Results The shoulder arthroplastyrepresented the treatments of choice for the patients with end-stage shoulder diseases and traumatic diseases. It could provide good and stable results in pain rel ief and functional outcomes. Conclusion There are still many controversies about the patterns of prosthesis, fixation ways and kinds of materials in cl inical practice. Currently, the main research is about the designs of the glenoid prosthesis and the cl inical practice in young patients.
ObjectiveTo observe the effect of ultra early joint movement onthe rehabilitation of shoulder joint function in patients with breast cancer who underwent axillary lymph node dissection (ALND).MethodsA total of 100 patients with breast cancer who underwent ALND between August 2018 and December 2019 in Zhongnan Hospital of Wuhan University were randomly divided into the early movement group (n=50) and the ultra early movement group (n=50). Both groups received early rehabilitation intervention as recommended by the guidelines. Patients in the early movement group started the shoulder joint movement training on the 7th day after surgery, and patients in the ultra early movement group started the shoulder joint movement training on the 3rd day after surgery, 3 times a day, 5 days a week, for 4 weeks. The changes in pain and drainage volume 3 days, 1 week, and 2 weeks after surgery and the changes of shoulder joint range of motion 1 week, 2 weeks , and 3 weeks after surgery were compared between the two groups, changes in shoulder function and quality of life 1 week and 3, 6, and 12 weeks after surgery were compared by the Constant-Murley and the Medical Outcomes Study 36-item Short-form Health Survey (SF-36) scales, respectively.ResultsThree days, 1 week, and 2 weeks after surgery, no significant difference in the pain scores or drainage volumes was observed between the two groups (P>0.05). One week, 2 weeks, and 3 weeks after operation, the motion ranges of shoulder abduction, flexion, and external rotation in the ultra early movement group were significantly better than those in the early movement group (P<0.05), and the motion range of shoulder internal rotation 1 week after operation in the ultra early movement group was significantly better than that in the early movement group (P<0.05). One week and 3, 6, and 12 weeks after operation, the Constant-Murley scores in the ultra early movement group were 25.9±4.3, 55.4±5.3, 64.6±4.5, and 73.3±4.6, respectively, which were better than those in the early movement group (21.3±3.8, 48.9±7.8, 57.3±4.7, and 70.7±3.0, respectively; P<0.05). No significant difference in the SF-36 scale scores was observed between the two groups (P>0.05).ConclusionsUltra early joint movement can significantly improve the motion range and functions of shoulder joint in patients with breast cancer who underwent ALND. What’s more, ultra early joint movement does not increase the early drainage volume or pain, and has no significant impact on the later quality of life. It is worthy of clinical application.
ObjectiveTo summarize the relationship between shoulder instability and superior labrum anterior posterior (SLAP) lesion. MethodsThe characteristics of shoulder instability and SLAP lesion were analyzed, and the relationship between them in pathogenesis, clinical symptoms, and biomechanics was discussed by referring to relevant domestic and foreign literature. ResultsShoulder instability and SLAP lesion can occur both spontaneously and respectively. SLAP lesion destroys the superior labrum integrity and the long head of biceps tendon (LHBT) insertion, causing excessive humeral head displacement against glenoid, and leading to shoulder instability. While chronic repetitive or acute high-energy traumatic shoulder instability can in turn aggravate SLAP lesion, resulting in expansion and increased degree of the original lesion. Conclusion SLAP lesion destroys mechanisms of shoulder stability, while shoulder instability causes tears of the upper labrum and the LHBT, showing a connection between shoulder instability and SLAP lesion. However, the existing evidence can only demonstrate that shoulder instability and SLAP lesion induce and promote the development of each other, instead of a necessary and sufficient condition. Therefore, the specific causal relationship between the two remains unknown and needs to be further studied.
In recent years, the development of artificial shoulder arthroplasty has been rapid, but postoperative patients often have problems such as joint swelling, pain, activity limitation, muscle strength decline and various complications, which need to be accompanied by standardized and correct rehabilitation treatment. In this paper, we review the postoperative rehabilitation treatment program of artificial shoulder arthroplasty, the selection of the timing of rehabilitation treatment, the continuity treatment of rehabilitation and the rehabilitation strategies to improve the clinical efficacy in the postoperative period, with a view to providing reference and basis for the development of a reasonable rehabilitation program for postoperative patients.
Objective To investigate the operative method and cl inical results of arthroscopic assisted treatment of shoulder dislocation combined with fracture of greater tuberosity of humerus. Methods From February 2006 to June 2008,12 cases of shoulder dislocation (6 left, 6 right) combined with greater tuberosity fractures were treated. There were 4 males and 8 females with an average of 58.5 years (range 34-79 years). Eleven cases fall down and one was crushed. The time from injury to hospital averaged 2.1 hours (range 30 minutes-24 hours). X-ray films revealed greater tuberosity fractures with average 5.8 mm (range 5-12 mm) displacement, and MRI showed Bankart lesion in 2 cases. Arthroscopic examination taken 3-14 days after reduction revealed 3 cases of Bankart lesion and 1 case of SLAP lesion. Three cases of great tuberosity fractures were fixed with canulated screws, 2 cases with absorbable screws, 7 cases with titanium suture anchor. Three cases were repaired under arthroscopy, and 9 cases were repaired under arthroscopic assistance mini-incision. Results All the incisions were healed at first intention without infection. All patients were followed up for 6-32 months (average 16 months). The shoulder joints were fixed stably without redislocation. Six months after operation, there were 3 cases with mild l imitation of abduction and 1 case with pain in flexion related with impingement. The X-ray films showed all fractures healed 2-6 months after operation (average 3.2 months). The American Shoulder and Elbow Surgeons and University of Cal ifornia at Los Angeles scores were 16.03 ± 1.03 and 32.65 ± 4.83, respectively. Eight cases were excellent, 3 were good, 1 were fair and the excellent and good rate was 91.7%. Conclusion For shoulder dislocation combined with fracture of greater tuberosity of humerus, the treatment by shoulder arthroscopy is a safe and mini-invasive operative method with comprehensively accurate intraoperation diagnosis, satisfying therapeutic effect, good functional recovery, as well as obvious rel ief of pain.
Objective To assess the therapeutic effect of acupuncture for shoulder hand syndrome after stroke. Methods We searched MEDLINE (1966 to Sep. 2008), EMbase (1980 to Sept. 2008), CBM (1978 to Sept. 2008), VIP (1989 to Sept. 2008), WANFANG Database (1998 to Sept. 2008), CNKI (1979 to Sept. 2008) and handsearched relevant journals and conference proceedings. We included all randomized controlled trials (RCTs) and quasi-RCTs of acupuncture treatment for patients with shoulder hand syndrome. We evaluated the internal validity of the RCTs and quasi-RCTs. If all included trials were of high quality and homogeneity, then the meta-analysis was conducted. Results Three RCTs were identified but due to the defects in quality and clinical differences between the trials, data from these trials were not combined through meta-analysis, and a descriptive analysis was performed. The results showed that acupuncture was effective for treating shoulder hand syndrome. Conclusions The results of our review suggest that acupuncture may be effective for treating houlder hand syndrome, but because of the defects in the methodological quality of included trials, further large sample, double-blind RCTs are urgently needed.