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Purpose There is still conflicting evidence to support postoperative rehabilitation protocols using immobilization following rotator cuff repair over early motion. The objective of the study was to evaluate the evolution of pain, shoulder function, and patients' perception of their health status up to 1 year after cuff rotator repair and a standard postoperative rehabilitation protocol consisting of 4 weeks of immobilization followed by a 2-week assisted controlled rehabilitation. Methods Descriptive, longitudinal, uncontrolled case-series study was performed on 49 patients who underwent arthroscopic rotator cuff repair following traumatic or degenerative lesions. VAS scale for pain, Constant–Murley score for function, and SF-12 score for quality of life were used as outcome measures and were administered before the rehabilitation treatment, at the end of the 2-week rehabilitation, 3 months, and 1 year after surgery. Results VAS pain score decreased significantly along the follow-up reaching almost a nil value after 1 year (0.2). Function as measured by Constant–Murley score had a significant improvement during follow-up, reaching a mean value of 84.6. The short form (SF)-12 score increased over time reaching 46.3 for the physical and 43.8 for the psychological dimension, respectively, at 1 year. Conclusion The present study confirmed an excellent outcome at 1 year after rotator cuff repair using a traditional 4-week immobilization followed by a 2-week rehabilitation protocol without evidence of tendon un-healing or re-tearing. Level of Evidence This is a level IV, therapeutic case series.

Purpose The objective of this study was to investigate the ability of elastosonography (USE) in the identification of different grades of muscular injuries, comparing its effectiveness with traditional ultrasound (US) survey and by relating the results to the clinical classification of muscular pain. Methods In the period between August 2014 and May 2016, we conducted a prospective cohort study on a population of 34 young male professional athletes belonging to the same under-17 football club (Ancona 1905). Injuries were recorded according to location, type, mechanism, recurrence, and whether they occurred with or without contact. Muscle pain was classified, after a physical examination, according to the classification of Mueller-Wohlfahrt et al. All athletes were evaluated by musculoskeletal US and USE in hours following the trauma/onset of pain. Results Seventy injuries were documented among 19 players. Muscle/tendon injuries were the most common type of injury (49%). USE showed areas of edema in nine lesions that were negative at the US examination and previously classified as fatigue-induced muscle disorders. These nine players took more time to return to physical activity compared with others with injuries classified into the same group, but negative at USE evaluation. Conclusion USE is a valuable aid in the diagnosis and prognostic evaluation of muscle injury, as it detects pathologic changes that are not visible with the B-mode US. Level of Evidence This is a Level III, observational cohort study.

Scapular winging secondary to dorsal scapular nerve (DSN) damage is an underestimated condition. It is often caused by entrapment of the nerve due to a hypertrophic middle scalene muscle, or by stretching of the DSN during traumatic movements. The condition has also been attributed to myofascial pain syndrome of the rhomboids with entrapment of the DSN. The non-specific symptomatology reported by patients is often incorrectly diagnosed, and this can result in a high level of disability of the upper limb.A clinical case of misdiagnosed dorsal scapula entrapment is presented. Satisfactory shoulder function recovery, pain relief and reduction of disability were obtained after correct diagnosis of the condition and a comprehensive rehabilitation approach.

The elbow, the middle joint of the upper limb, enables the hand to be placed at various distances from the body. The articular, muscular and neuromotor complexity of the elbow is such that it is often prone to stiffness, especially if immobilized for long periods of time. Therefore, mobilization of the posttraumatic elbow must be started early. In the presence of lesions to the ligamentous structures, the joint must be protected to prevent these structures from being placed under tension during movement. Rehabilitation of the elbow includes the use of braces. Different types of brace are used depending on clinical situation and the objectives to be achieved. They can have fixed protection or locked articulation, allow an adjustable range of movement to restrict flexion-extension and pronation-supination, or allow dynamic and static progressive movement. The latter plays a special role in conservative treatment and following surgical release. However, the effectiveness of braces in the rehabilitation treatment of elbow stiffness depends on the patient’s compliance. Their use requires a considerable amount of physician time to achieve the objectives envisaged by the rehabilitation program.