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Purpose: To investigate the effects of Mulligan thoracic sustained natural apophyseal glides (SNAGS) techniques and traditional exercises on pain, shoulder function, size of sub-acromial space, and shoulder joint range in patients with sub-acromial impingement syndrome. Methods: Seventy-four patients with sub-acromial impingement syndrome (25 to 40 years) joined this research and were allocated randomly into two equal groups; experimental group A (Mulligan SNAGS and exercise) and control group B (exercise only). All patients were assessed by visual analogue scale (VAS) for pain intensity, Shoulder Pain and Disability Index (SPADI) for shoulder function, plain x-ray for the size of sub-acromial space, and goniometer for shoulder range of motion (ROM). The measurements were performed at two intervals (baseline and after four weeks of intervention). Results: After 4 weeks of intervention, there were statistically significant differences between groups, in favor of Mulligan SNAGS, on sub acromial space size, pain intensity, shoulder function, and shoulder joint range of motion (p < 0.05). In within-group analysis, there were also statistically significant differences between pre- and post-treatment in all measured variables (p < 0.05). Conclusion: Mulligan thoracic spine (SNAGS) mobilization into extension and traditional exercises improve sub acromial space size, pain intensity, shoulder function, and shoulder joint range of motion in patients with sub acromial impingement syndrome. It is recommended to mobilize the thoracic spine by mulligan SNAGS in the treatment of sub-acromial impingement syndrome. [ABSTRACT FROM AUTHOR]

Background: Both scapular dynamics and static scapular position are important in the treatment of shoulder dysfunction. This study aimed to create an index that can evaluate scapular position on plain radiographs and evaluate the relation between scapular position and posture accurately. Methods: Using four fresh frozen cadavers, we developed a glenoid angle grade based on the degree of overlap between the shadow of the coracoid inflection point and the upper edge of the scapula on frontal plain radiographs: grade 1, no overlap; grade 2, overlaps by less than half of the shadow; grade 3, overlaps by more than half. We then performed a retrospective cohort study that included 329 shoulders of 329 patients who underwent spine surgery. Spine alignment parameters (SPAPs), including cervical lordosis (CL), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence, pelvic tilt, sacral slope, and sagittal vertical axis were measured on standing lateral plain radiographs. Glenoid anterior tilt (GAT) and glenoid anteversion angle (GAVA) were calculated on frontal radiographs and three-dimensional computed tomography scans. Correlations between SPAPs and each angle were investigated, and independent influencing factors were sought in multivariate analysis. Individual factors, GAT, GAVA, and SPAPs were compared among the grades. Results: SPAPs associated with GAT were sagittal vertical axis (R = 0.14, P = .011), TK (R = 0.12, P = .026), and LL (R = −0.11, P = .046). Multivariate analysis identified TK and LL as independent influencing factors (TK, P = .001; LL, P = .008). SPAPs associated with GAVA were CL (R = 0.17, P = .002), TK (R = 0.29, P < .001), and LL (R = 0.25, P < .001). Multivariate analysis identified CL, TK, and LL as independent influencing factors (CL, P = .01; TK, P = .03; LL, P = .03). There were 183, 127, and 19 cases categorized as grades 1, 2, and 3. GAT (grade 1, 24.0 ± 7.8; 2, 32.4 ± 7.0; 3, 41.0 ± 7.8), GAVA (1, 29.3 ± 7.6; 2, 33.7 ± 9.5; 3, 31.5 ± 8.3), and TK (1, 30.6 ± 13.6; 2, 35.1 ± 14.2; 3, 43.1 ± 20.4) differed significantly according to grade. Conclusion: We identified factors that influence scapular position and demonstrated that scapular position can be estimated by a grading system using plain radiographs.

Background: This study aims to analyze the safety and clinical efficacy of using double posterolateral coaxial portals for endoscopic treatment of posterior ankle impingement syndrome (PAIS), a procedure that has gained popularity in recent times. Methods: Six fresh foot samples were randomly selected to measure the distances of two posterolateral portals to the sural nerve in different positions (plantar flexion 10°, dorsiflexion 30°, and plantar flexion 30°) for safety evaluation. A prospective analysis was conducted on the clinical efficacy of the operative approach for endoscopic management of posterior ankle impingement syndrome, including evaluation of effectiveness and complications. Results: In this study, the mean distances of the first and second portals to the sural nerve were measured in different ankle positions. The distances were found to be 2.26 ± 0.22 cm and 1.59 ± 0.12 cm in the plantar flexion 10° position, 2.21 ± 0.21 cm and 1.55 ± 0.12 cm in the dorsiflexion 30° position, and 2.46 ± 0.29 cm and 1.73 ± 0.19 cm in the plantar flexion 30° position, demonstrating a significant safety margin from the nerve. A total of 38 patients underwent endoscopic treatment for posterior ankle impingement syndrome using double posterolateral coaxial portals between January 2012 and December 2017. This surgical approach provided access to the subtalar joint and posterior ankle region. The patients were followed up for an average of 38.2 months (24–72 months), with a satisfaction rate of 94.7%. There were no reported complications, and significant improvements were observed in both visual analogue scale (VAS) and The American Orthopedic Foot and Ankle Society Score (AOFAS) scores postoperatively. The VAS score decreased from 5.68 to 0.51 (P

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Anterior ankle impingement is a frequent cause of chronic ankle pain and swelling. A pathological examination has been reclassified as “anterior ankle impingement syndrome.” Soft tissue impingement is prevalent in the anterolateral compartment of the ankle, while a bony spur often causes impingement in the anteromedial compartment. Although open surgery has yielded good outcomes historically, it is associated with several complications. On the other hand, the development of ankle arthroscopy has reduced these risks significantly and has been used effectively in numerous studies to treat impingements caused by anterior bony spurs or soft tissue. An accurate preoperative clinical diagnosis and diagnostic imaging are critical for surgical planning, particularly for identifying bony spurs in front of the ankle. Narrowing joint space, large bone fragments, and other factors can influence the surgical outcomes. Computed tomography scans precisely evaluate the bony spur size, while magnetic resonance imaging scans help assess soft tissue lesions. Therefore, understanding diagnosis and treatment is important, and an accurate understanding of patient prognostic factors, such as osteoarthritis and degenerative osteoarthritis, eventually affects patient outcomes. This paper discusses the clinical symptoms, causes, diagnosis, surgical method, and postoperative rehabilitation of anteromedial and anterolateral ankle impingement syndrome and reports the results of arthroscopic surgery. [ABSTRACT FROM AUTHOR]

Knochen ist elastisch und verformbar. Kehrt ein Knochen nach Trauma, chronischer Einwirkung von Zug, Druck oder Torsion nicht in die alte Position zurück, verbleiben Schmerzen im Knochen und in den beteiligten, nicht dehnbaren Faszien, Sehnen, Kapsel- und Bandstrukturen. Nachdem mit dem Strain-Relief-Konzept im Teil 1 (Heft 4/2023) [ 1 ] die theoretischen Grundlagen des neuen manuellen Verfahrens zur Behandlung chronischer Schmerzen im Bewegungsapparat vorgestellt wurde, folgte im Teil 2 (Heft 1/2024) [ 2 ] die praktische Anwendung der Technik an der unteren Extremität. Diesmal wird gezeigt, wie man manuell die Knochen an der oberen Extremität vom Strain befreien kann und damit erfolgreich Schmerzen mindert oder sogar beseitigt. Bone is elastic and malleable. However, if a bone does not return to its original shape after trauma, chronic traction, pressure or torsion, pain will remain in the bone and in the non-stretchable fascia, tendons, capsule and ligament structures involved. Following the introduction of the theoretical basis of a new manual method for the treatment of chronic pain in the musculoskeletal system with the strain-relief-concept in part 1 (issue 4/2023) [ 1 ], the second part (issue 1/2024) [ 2 ] dealt with the practical application of the concept to the lower extremity. This time it is shown how the bones of the upper extremity can manually be freed from the strain, thus successfully reducing or even eliminating pain. [ABSTRACT FROM AUTHOR]

Background and Objective: The aim of this study was to analyze trends in surgical and non-surgical service utilization for common shoulder disorders in Korea from 2010 to 2019. Methods and Materials: This retrospective, cross-sectional, descriptive study utilized National Patient Sample data from the Health Insurance and Review Assessment Service (HIRA) of Korea. These data constitute a 2% sample out of the entire Korean population and include data for a variety of parameters instrumental for health care research. Patients with at least one medical service use for rotator cuff syndrome or tear, impingement syndrome, or adhesive capsulitis between January 2010 and December 2019 were included. Trends in healthcare utilization by disorder type, patient demographics, seasonal service use, and treatment details were examined. Results: There was an upward trend in the total number of patients and costs for shoulder disorders, from 35,798 patients and USD 5,485,196 in 2010 to 42,558 and USD 11,522,543 in 2019, respectively. The number of patients aged ≥60 and hospital visits increased. March had the highest number of claims. Physical therapy was the most common non-surgical procedure, while nerve block claims more than doubled. Opioid prescription rates also tripled. Surgical treatments were dominated by shoulder rotator cuff repair and acromioplasty. Conclusions: There was a significant increase in healthcare utilization for shoulder disorders, marked by rising costs and patient numbers. The use of nerve blocks and opioids notably increased. These data are valuable for clinicians, researchers, and policymakers. [ABSTRACT FROM AUTHOR]

Background: Shoulder impingement syndrome is a clinical situation that presenting with shoulder pain, difficultly and weakness. Present study designed for evaluating the effect of radiofrequency and corticosteroid injection in longterm treatment follow up for pain reduction and functional evaluation of shoulder joint. Methods: Sixty patients were analyzed equally in two treatment groups. Post-treatment follow up at one, four and twelve weeks after procedures were carried out using Visual Analog Scale (VAS) for pain relief, Shoulder Pain and Disability Index (SPADI) for shoulder function and Beck Depression Inventory (BDI). Results: Both treatment groups showed significantly pain reduction (P-value

Background: The coracoacromial ligament is a triangular band, which extends between the coracoid process and the acromion. This ligament, along with the coracoid process and the acromion, forms arch above the humeral head which protects the head of the humerus during abduction. It is important for gleno humeral stability. Coracoacromial ligament may be composed of two strong marginal bands with thinner centre.It may be present in the form of a thick anterolateral bundle and a posteromedial bundle, with a triangular base. Anatomic variants are frequently seen .Sometimes it is Y-shaped, quadrangular and may be straight in shape. Release of Coracoacromial ligament for the treatment of shoulder impingement syndrome has been suggested in surgeries. Aim and Objectives: Aim of the present study is to study the different types of coracoacromial ligament. Cadaveric study was helpful for identifying the types of normal coracohumeral ligaments. Methodology: Fifty upper limbs were procured from the cadavers. Cadavers were embalmed and in 10% formalin. Inclusion criteria for study were intact shoulder joint. Exclusion criteria were disarticulated shoulder joint. Dissection was carried out as per steps given in Cunningham dissecting manual. As dissection of upper limb was already done by undergraduate students, skin was reflected and deltoid was exposed. For further dissection the anterior and middle fibers of deltoid muscle were cut Superior surface of coracoid process and acromion process were exposed to visualised the coracoacromial ligament. Results: Meticulously dissected upper limbs were observed to determine various shapes of CAL. Trapezoid, rectangular, Y shaped, bipartite and tripartite type of choracoacromial ligaments were observed. Conclusion: Advances in understanding Coracoacromial ligament through research outcomes will contribute more to intraoperative decision making for arthroscopic surgeons. Background: The coracoacromial ligament is a triangular band, which extends between the coracoid process and the acromion. This ligament, along with the coracoid process and the acromion, forms arch above the humeral head which protects the head of the humerus during abduction. It is important for gleno humeral stability. Coracoacromial ligament may be composed of two strong marginal bands with thinner centre.It may be present in the form of a thick anterolateral bundle and a posteromedial bundle, with a triangular base. Anatomic variants are frequently seen .Sometimes it is Y-shaped, quadrangular and may be straight in shape. Release of Coracoacromial ligament for the treatment of shoulder impingement syndrome has been suggested in surgeries. Aim and Objectives: Aim of the present study is to study the different types of coracoacromial ligament. Cadaveric study was helpful for identifying the types of normal coracohumeral ligaments. Methodology: Fifty upper limbs were procured from the cadavers. Cadavers were embalmed and in 10% formalin. Inclusion criteria for study were intact shoulder joint. Exclusion criteria were disarticulated shoulder joint. Dissection was carried out as per steps given in Cunningham dissecting manual. As dissection of upper limb was already done by undergraduate students, skin was reflected and deltoid was exposed. For further dissection the anterior and middle fibers of deltoid muscle were cut Superior surface of coracoid process and acromion process were exposed to visualised the coracoacromial ligament. Results: Meticulously dissected upper limbs were observed to determine various shapes of CAL. Trapezoid, rectangular, Y shaped, bipartite and tripartite type of choracoacromial ligaments were observed. Conclusion: Advances in understanding Coracoacromial ligament through research outcomes will contribute more to intraoperative decision making for arthroscopic surgeons.

According to various estimates, shoulder pain covers 7-26% of all diseases faced by the global population. In addition, according to studies by Scandinavian scientists, up to 18% of the population's loss of working capacity and paid sick leave are caused by shoulder pain. According to experts, the number of these diseases is already approaching epidemic levels in Sweden, Finland, Japan, and the United States. Insurance payments for diseases caused by shoulder pain are second only to vertebrogenic pain. Subacromial impingement syndrome is the main cause of this pain. Diagnosis includes a complex of clinical and instrumental research methods. A reliable diagnosis of the presence of subacromial impingement syndrome, as well as the type, nature, and severity of subacromial muscle compression, is achieved using modern methods for visualizing the internal structures of the shoulder. It should be noted that radiography and ultrasound are important among them. To determine the model performance of artificial intelligence in detecting rotator cuff pathology using different imaging modalities and to compare its capability with that of physicians in clinical scenarios. Neck-shoulder syndrome is one of the most frequent causes of disability in the population, accounting for 18% of disability sheets. The treatment of pathologies attracts physicians of various specialties: orthopedic traumatologists, neurosurgeons, anesthesiologists, resuscitators, surgeons, neurologists, therapists, physiotherapists, and physical therapy physicians. [ABSTRACT FROM AUTHOR]

Subacromial impingement (SAI) is associated with shoulder pain and dysfunction and is exacerbated by rotator cuff tears; however, the role of acromioplasty in mitigating subacromial contact in the rotator cuff deficient shoulder remains debated. This study aimed to quantify the influence of isolated and combined tears involving the supraspinatus on subacromial contact during abduction; and second, to evaluate the influence of acromioplasty on joint space size and subacromial contact under these pathological conditions. Eight fresh‐frozen human cadaveric upper limbs were mounted to a computer‐controlled testing apparatus that simulated joint motion by simulated force application. Shoulder abduction was performed while three‐dimensional joint kinematics was measured using an optoelectronic system, and subacromial contact evaluated using a digital pressure sensor secured to the inferior acromion. Testing was performed after an isolated tear to the supraspinatus, as well as tears involving the subscapularis and infraspinatus‐teres minor, both before and after acromioplasty. Rotator cuff tears significantly increased peak subacromial pressure (p < 0.001), average subacromial pressure (p = 0.001), and contact force (p = 0.034) relative to those in the intact shoulder. Following acromioplasty, significantly lower peak subacromial contact pressure, force and area were observed for all rotator cuff tears involving the supraspinatus at 30° of abduction (p < 0.05). Acromioplasty predominantly reduces acromion thickness anteriorly thereby reducing subacromial contact in the rotator cuff deficient shoulder, particularly in early to mid‐abduction where superior glenohumeral joint shear force potential is large. These findings provide a biomechanical basis for acromioplasty as an intervention for SAI syndrome and as an adjunct to rotator cuff repairs. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the frequency of non-traumatic chronic shoulder pain sonographically in the local population. METHODOLOGY: This cross-sectional study was conducted at the Department of Radiology, Combined Military Hospital Malir, from March to October 2020. A history of shoulder pain of more than one-month duration was included. Patients with a History of shoulder dislocation, neurological, renal, hepatic and cardiac diseases were excluded. The sample size was 196. A non-probability consecutive sampling technique was employed. SPSS version 23 was used for statistical analysis. RESULTS: 196 patients (69.9% males and 30.1% females) with non-traumatic shoulder pain (56.4 % right side and 43.4% left) were scanned. The mean age was 42.80±11.20 years. Out of 196, 118(60.2%) were having complaints in dominant limbs (right 51.0% and left 9.2%); 78(39.8%) were having pain in non-dominant limbs (right 6.6% and left 33.2%). Significant findings were supraspinatus partial tear (46.9%), sub-acromial sub-deltoid bursitis(8.2%), and biceps tenosynovitis(6.1%), adhesive capsulitis, a complete tear of supraspinatus tendon, impingement syndrome, joint effusion, subscapularis tendon tear and tenosynovitis. 44(22.4%) patients had two pathologies, and 31 (15.8%) patients had three pathologies, respectively. Significant co-existent findings were biceps tenosynovitis (13.8%), Impingement syndrome (9.2%), bursitis (8.2%) and joint effusion (7.1%). Age and number of pathological were moderately positively correlated, r (194) = 0.46, p < 0.01 and keeping CI = 95%. CONCLUSION: Partial tears of the supraspinatus tendon were the most common pathology in non-traumatic shoulder myalgia, diagnosed on ultrasound, followed by sub-acromial sub-deltoid bursitis and biceps tenosynovitis, having moderate linear relation with age.

Chronic shoulder pain (CSP) is a clinical syndrome associated with inflammatory and degenerative musculoskeletal changes, characterized by pain in the shoulder that persists for at least 3 months, arising or aggravated by functional activity in this area. The frequency of CSP in the modern population reaches 20–33%, it is one of the leading causes of severe suffering, disability and seeking for medical attention. The main causes of CSP are shoulder rotator impingement syndrome (subacromial impingement syndrome), calcific tendinitis, adhesive capsulitis, shoulder and acromioclavicular joint osteoarthritis. Accurate diagnosis of these diseases is necessary for the correct choice of treatment. Differential diagnosis is carried out using tests that evaluate the function of the shoulder joint and the rotator cuff muscles (Neer, Speed, Hawkins tests, etc.), as well as using instrumental methods (ultrasound, magnetic resonance tomography, X-ray). In CSP, it is necessary to exclude septic, oncological, visceral, systemic rheumatic and other diseases, as well as musculoskeletal pathology of the cervical spine, upper chest and back, which can cause pain in the shoulder region.Therapy for diseases that cause CSP should be personalized and complex, aimed at maximum pain control and restoration of function. For this purpose, non-steroidal anti-inflammatory drugs, local injection therapy with glucocorticoids, hyaluronic acid, and platelet-rich plasma are used. In some cases, muscle relaxants, antidepressants, anticonvulsants, local injections of botulinum toxin type A are indicated. Physiotherapy and medical rehabilitation methods play a fundamental role in the treatment of CSP.

OBJECTIVES The purpose of this study is to investigate the effect of applying a very minimal weight bearing in the early phase of a general rehabilitation program for returning to sports after periacetabular osteotomy for developmental dysplasia of the hip in physically active populations. METHODS A 22 year-old NCAA Division I female water polo player, with no prior history of hip injury and no signs of developmental dysplasia of the hip (DDH), reported to athletic training facility early season complaining of right hip pain after stationary bike workout. The athlete reported hearing and feeling a sudden “pop” within the right hip with immediate hip pain when she was pedaling at moderate intensity of a stationary bike. Numbness and tingling was felt initially with the mechanism. Tender to palpate at the right hip flexor and anterior hip joint, as well as the greater trochanter. The athlete’s chief complaints were pain with walking and prolonged sitting. Antalgic gait noticed during evaluation. A 6-, 12-, and 24-week rehabilitation protocol were performed. RESULTS X-ray and MRI images showed no avascular necrosis or fracture. An abnormal alpha angle found and no bursitis or tendonitis was shown. A periacetabular osteotomy (PAO) was performed to rotate the acetabular fragment into optimal position and fixed to the pelvis with 3 screws. During the initial 6-week of post-surgical rehabilitation, the level of pain and edema were minimized, the athlete was able to perform toe-touch and partial weight-bearing with crutches, and restored hip ROMs. From 6 to 10 weeks, the athlete recovered full hip ROMs and able to perform lunges, leg press, deadlifts, mini squats back to pre-injury status. The athlete was able to return to activities of daily living (ADLs) after 12 weeks. At 24 weeks, the athlete was able to fully participate in sports without limitations. CONCLUSIONS This case describes the rehabilitation program employed following PAO for an atypical case of DDH in a water polo athlete who had no signs and symptoms of DDH prior to sports participation. At the end of the season, the athlete opted to undergo PAO given the risks and underwent a 6-month rehabilitation before a full return to function. This case report aides with treatment knowledge and postsurgical rehabilitation techniques for athletic trainers.

Introduction: Shoulder problems are the second most common disease of the musculoskeletal system. Background: The most common cause of these problems is impingement syndrome. The aim of our work was to point out the possibilities of conservative treatment for impingement syndrome. In this work, we tried to draw attention to the deterioration in the quality of life caused by shoulder problems and we wanted to improve the range of motion in the shoulder to flexion, abduction, and reduce pain due to the chosen physiotherapy procedures. Our work has a theoretical part, in which we approach the impingement syndrome, its examination and treatment. Material and methods: In the practical part, we used a clinical study with a questionnaire method to achieve the goal of our work. Th e group consisted of 20 patients with impingement syndrome, in whom we used manual therapy, kinesiotherapy, electrotherapy, and Kinesio taping. Using a questionnaire, we were able to assess how much impingement affects the quality of life. Results: Due to the methods we chose, we managed to improve the range of motion of the arm, where the average value at the initial measurement was 119.25° to flexion and 113° to abduction. In the output measurement, the average value up to flexion was 163.25° and up to abduction 165.75°. Conclusion: We also reduced the overall pain, which averaged 6.90 at baseline and 2.90 at the end. Based on our results we recommend a combination of methods to be used in impingement

OBJECTIVE: To evaluate the frequency of non-traumatic chronic shoulder pain sonographically in the local population. METHODOLOGY: This cross-sectional study was conducted at the Department of Radiology, Combined Military Hospital Malir, from March to October 2020. A history of shoulder pain of more than one-month duration was included. Patients with a History of shoulder dislocation, neurological, renal, hepatic and cardiac diseases were excluded. The sample size was 196. A non-probability consecutive sampling technique was employed. SPSS version 23 was used for statistical analysis. RESULTS: 196 patients (69.9% males and 30.1% females) with non-traumatic shoulder pain (56.4 % right side and 43.4% left) were scanned. The mean age was 42.80±11.20 years. Out of 196, 118(60.2%) were having complaints in dominant limbs (right 51.0% and left 9.2%); 78(39.8%) were having pain in non-dominant limbs (right 6.6% and left 33.2%). Significant findings were supraspinatus partial tear (46.9%), sub-acromial sub-deltoid bursitis(8.2%), and biceps tenosynovitis(6.1%), adhesive capsulitis, a complete tear of supraspinatus tendon, impingement syndrome, joint effusion, subscapularis tendon tear and tenosynovitis. 44(22.4%) patients had two pathologies, and 31 (15.8%) patients had three pathologies, respectively. Significant co-existent findings were biceps tenosynovitis (13.8%), Impingement syndrome (9.2%), bursitis (8.2%) and joint effusion (7.1%). Age and number of pathological were moderately positively correlated, r (194) = 0.46, p < 0.01 and keeping CI = 95%. CONCLUSION: Partial tears of the supraspinatus tendon were the most common pathology in non-traumatic shoulder myalgia, diagnosed on ultrasound, followed by sub-acromial sub-deltoid bursitis and biceps tenosynovitis, having moderate linear relation with age. [ABSTRACT FROM AUTHOR]

Teaching point: Prefemoral fat pad impingement syndrome is one of the fat pad impingements of the knee and can be assessed with ultrasonography.

Background and Objective: The aim of this study was to analyze trends in surgical and non-surgical service utilization for common shoulder disorders in Korea from 2010 to 2019. Methods and Materials: This retrospective, cross-sectional, descriptive study utilized National Patient Sample data from the Health Insurance and Review Assessment Service (HIRA) of Korea. These data constitute a 2% sample out of the entire Korean population and include data for a variety of parameters instrumental for health care research. Patients with at least one medical service use for rotator cuff syndrome or tear, impingement syndrome, or adhesive capsulitis between January 2010 and December 2019 were included. Trends in healthcare utilization by disorder type, patient demographics, seasonal service use, and treatment details were examined. Results: There was an upward trend in the total number of patients and costs for shoulder disorders, from 35,798 patients and USD 5,485,196 in 2010 to 42,558 and USD 11,522,543 in 2019, respectively. The number of patients aged ≥60 and hospital visits increased. March had the highest number of claims. Physical therapy was the most common non-surgical procedure, while nerve block claims more than doubled. Opioid prescription rates also tripled. Surgical treatments were dominated by shoulder rotator cuff repair and acromioplasty. Conclusions: There was a significant increase in healthcare utilization for shoulder disorders, marked by rising costs and patient numbers. The use of nerve blocks and opioids notably increased. These data are valuable for clinicians, researchers, and policymakers.

Introduction: The coracoacromial arch, which extends laterally over the shoulder joint, is formed by the acromion process, coracoid process, and coracoacromial ligament. The acromion process plays an important role in shoulder joint formation. Morphological variations of the acromion process play a key role in determining the subacromial space. Acromioplasty is an important step in rotator cuff repair. Aim: To investigate the morphometry of the acromion process in dry human scapulae and determine the various types of acromion processes. Materials and Methods: An observational cross-sectional study was conducted in the Department of Anatomy at NRI Medical College and General Hospital, Chinakakani, Guntur, Andhra Pradesh, India. The study duration was one year and four months, from November 2020 to March 2022. A total of 100 dry human scapulae (50 right and 50 left) of unknown age and gender were included. Various types of acromion processes were identified. Measurements were taken using a digital vernier caliper (accurate to 0.01 mm) and protractor to measure parameters such as length, breadth, and thickness of the acromion process, acromiocoracoid distance, acromioglenoid distance, height of the coracoacromial arch, acromial slope, and acromial tilt. The data were analysed using Statistical Package for Social Sciences (SPSS) version 24.0. Mean, Standard Deviation (SD), and range were calculated for each morphometric parameter. Results: Three types of acromion processes were observed: type I (31%), type II (48%), and type III (21%). The mean length, breadth, and thickness of the acromion process were 43.21±2.82 mm, 25.48±2.56 mm, and 6.84±1.24 mm, respectively. The mean acromiocoracoid distance, acromioglenoid distance, and height of the coracoacromial arch were 39.87±7.63 mm, 27.34±3.58 mm, and 21.52±1.98 mm, respectively. The mean acromial slope and acromial tilt observed were 32.34±4.62° and 37.46±6.37°, respectively. Conclusion: The present study provides data on the shape, dimensions, slope, tilt, and various distances of the acromion process in dry human scapulae. The majority of the scapulae on both sides exhibited type II acromion process.

The Shoulder Rating Questionnaire (SRQ) was created in the English language to assess shoulder disorders in six areas: global function, pain, daily activities, recreational and athletic activities, and work. The study aimed to translate and culturally adapt Shoulder Rating Questionnaire (SRQ) into Greek. The SRQ English version was translated and adapted into the Greek language using forward translation, expert panel synthesis, and backward translation procedures. A pilot testing has been made in the target population, and the final version was created. A cross-sectional study was conducted in clinical settings with the SRQ and the Shoulder Pain and Disability Index. A total of 168 Greek adult patients with rotator cuff-related shoulder pain were recruited from physical therapy clinics. Τhe reliability of the SRQ Greek version was assessed using intraclass correlation coefficients. Internal consistency was assessed using the Cronbach alpha coefficient. Concurrent validity was measured by correlating the Shoulder Rating Questionnaire with the Shoulder Pain and Disability Index using Pearson's correlation coefficient. The results showed that the SRQ Greek version has excellent internal consistency (Cronbach's α = 0.99), test–retest reliability (ICC = 0.976), and concurrent validity (r > 0.9). No ground or ceiling effects were found. The standard error of measurement and the minimum detectable change of the total score were 5.55 and 15.38. The Greek Language Version of the SRQ is a reliable and valid instrument that can be used to evaluate adult patients with shoulder rotator cuff-related disorders in the acute or chronic phases and in clinical trials. [ABSTRACT FROM AUTHOR]

Context: To determine optimal treatment strategies for shoulder impingement syndrome (SIS). Objective: To compare subacromial nonsteroidal anti-inflammatory injections (SNIs) and subacromial corticosteroid injections (SCIs) on pain relief and functional improvement in individuals with SIS. Second, to perform a cost analysis of the 2 injections. Data Sources: MEDLINE, SPORTDiscus, CINAHL, Embase, Web of Science, and SCOPUS databases were searched for randomized controlled trials using several keywords. Study Selection: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized, and 10 studies comparing changes in pain or function in humans with SIS receiving SNIs or SCIs were included. Quality and risk of bias were assessed using the Consolidated Standards of Reporting Trials (CONSORT) 2010 scale and the Cochrane Collaboration tool. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 1. Data Extraction: Baseline and follow-up scores of the visual analog, Constant-Murley, and University of California Los Angeles shoulder scales were extracted to calculate effect sizes (ESs), represented as Cohen d. Metaregression and publication bias analyses were performed. Procedural and medication costs were extracted from Medicare guidelines. Results: A total of 7 high and 3 good quality studies were included, with a mean score of 21.1. Only 1 study had a high risk of bias. The meta-analyses produced pooled ESs of 0.05 (P = 0.83), 0.12 (P = 0.71), and 0.07 (P = 0.79) for each scale, respectively, with CIs crossing 0. Procedural costs were equal between groups, whereas ketorolac was the least costly medication ($0.47). There was no significant difference in side effects between the 2 injections. Conclusion: SNIs are as effective as SCIs for short-term pain relief and improving function in patients with subacromial impingement syndrome. In addition, they are less expensive and cause no major difference in complications, providing a viable, cost-effective alternative for injection therapy in patients with SIS. [ABSTRACT FROM AUTHOR]

Pain in the shoulder joint is one of the most common reasons for seeking medical help associated with the pathology of the musculoskeletal system. The most common disease in this area that causes chronic pain is impeachment syndrome (IS) of the rotator muscles of the shoulder. The domestic literature describes in sufficient detail surgical and conservative approaches for lesions of the shoulder joint, but there are only a few publications on the types of IS. This review is devoted to the description of all occurring types of compression of the tendons of the muscles of the rotator cuff of the shoulder joint within the framework of IS.

Extensive literature reports an increase in physical disorders (pain, pathologies, dysfunctions) and mental malaise/uneasiness (stress, burnout) affecting dental professionals in relation to fast and pressing rhythms of work, long working hours, increasingly demanding patients, ever-evolving technologies, etc. This project has been conceived to bring the science of yoga around the world to dental professionals as a preventive (occupational) medicine and to provide knowledge and means for self-care. Yoga is a concentrative self-discipline of the mind, senses, and physical body, that requires regular daily exercise (or meditation), attention, intention, and disciplined action. M&M: The study aimed to design a Yoga protocol specifically devised for dental professionals (dentists, dental hygienists, and dental assistants) including positions (asanā) to be practiced/used in the dental office. The protocol is targeted for the upper body, namely neck, upper back, chest, shoulder girdle, and wrists, being areas greatly affected by work-related musculoskeletal disorders. This paper represents a yoga-based guideline for the self-cure of musculoskeletal disorders among dental professionals. Results: The protocol includes both sitting (Upavistha position) and standing (Utthana or Sama position) asanā, with twisting (Parivrtta), side bending (Parsva), flexion and forward bending (Pashima), and extension and arching (Purva) asanā to mobilize and decompress, and to provide nourishment and oxygen to the musculo-articular system. The paper delivers different concepts and theories developed and deepened by the authors and introduces and spreads yoga as a medical science among dental professionals for the prevention and treatment of work-related musculoskeletal disorders. We articulate notions ranging from stretching out using the vinyasā method (breath-driven movement) and inward-focused attention to contemplative/concentrative science, interoceptive attention, self-awareness, the mind–body connection, and receptive attitude. The theory of “muscles are bone ties” is coined and delivered with regard to tensegrity musculoskeletal fascial structures connecting, pulling together, and nearing the bone segments where they are anchored. The paper describes over 60 asanā envisaged to be performed on dental stools or using the walls of a dental office or a dental unit chair. A detailed guideline on the work-related disorders that can find relief with the protocol is provided, including the description of breath control for the practice of asanā in vinyasā. The foundations of the technique reside in the Iyengar Yoga method and Parinama Yogā method. Conclusions: This paper represents a guideline for self-cure in the prevention or treatment of musculoskeletal disorders affecting dental professionals. Yoga is a powerful concentrative self-discipline able to provide physical and mental well-being, representing great help and support in daily life and business for dental professionals. Yógasanā restores retracted and stiff muscles, giving relief to the strained and tired limbs of dental professionals. Yoga is not intended for flexible or physically performing persons but for people who decide to take care of themselves. The practice of specific asanā represents a powerful tool for the prevention or treatment of MSDs related to poor posture, forward head, chronic neck tension (and related headache), depressed chest, compressive disorders on wrists and shoulders as carpal tunnel, impingement syndromes, outlet syndrome, subacromial pain syndrome and spinal disc pathologies. Yoga, as an integrative science in medicine and public health, represents a powerful tool for the prevention and treatment of occupational musculoskeletal disorders and an extraordinary path for the self-care of dental professionals, sitting job workers, and healthcare providers suffering from occupational biomechanical stresses and awkward postures. [ABSTRACT FROM AUTHOR]

Background: To explore the value of MRI upon diagnosis of ischiofemoral impingement syndrome (IFI) and to recognise deformation or oedema of the quadratus femoris muscle. MRI applied to measure the ischial femoral space (IFS), the average width of quadratus femoral space (QFS), and the ischial intertuberal diameter. Methods: A retrospective analysis was carried out of 213 hip joints MRI images of 58 cases diagnosed with IFI and 61 cases of normal subjects. IFS, QFS and ischial intertuberal diameter were measured by axial T1WI sequence. The morphological and signal changes of the quadratus femoris muscle were observed through proton density weighted image fat suppression sequence (PDWI-FS). Results: The widths of IFS and QFS in the normal group were larger than those in the case group, while the ischial intertuberal diameter was significantly smaller (p < 0.05). Pearson correlation analysis revealed that there was a positive correlation (r = 0.824) between IFS and QFS in all hip joints and a negative correlation between the ischial intertuberal diameter and the widths of IFS and QFS (r = −0.213, −0.222, p < 0.05) respectively. As the grade of oedema in quadratus femoris muscle increased, the corresponding IFS gradually decreased. The corresponding IFS width of grade 0 oedema of the quadratus femoris muscle oedema was significantly higher than that of grade 1, grade 2 and grade 3. The receiver operating characteristic curve (ROC) of the subjects was applied to determine the diagnostic boundary value of the IFS and QFS in IFI patients, which was 1.98 cm and 1.05 cm respectively. The area under the curve (AUC) was 0.948 and 0.953 respectively. Conclusions: MRI examination could provide a reliable basis for the diagnosis of ischiofemoral impingement syndrome. The narrowing of IFS and QFS with deformation and oedema in the quadratus femoris muscle may be the features of manifestation of IFI. [ABSTRACT FROM AUTHOR]

Background: Rotator cuff tendinitis and shoulder impingement are regarded as the frequent intrinsic reasons for shoulder discomfort and disability. Objective: A study was conducted to compare the effects of conventional physical therapy and progressive overload training in patients with shoulder impingement syndrome. Methods: Thirty patients with shoulder impingement syndrome were included. These patients were randomised into two groups. One group received structured, progressive resistance training, and the other received conventional therapy. The intervention group participants participated in progressive resistance training three days per week for six weeks. The numeric pain rating scale was used to assess pain intensity and the range of motion measured by the goniometer. The statistical package for social sciences (SPSS), version 21 for Windows, was used for data analysis. An independent t-test was used to compare the effects between the two groups. Result: Out of 30 participants, there were twenty-four females and six males. The mean age of the participants was 44±5.1 years. Participants from the intervention group had better pain control (P < 0.05) and improved range of motion (P < 0.05) compared to the control group. Conclusion: We conclude in this group of patients, progressive overload training was more effective in alleviating pain and improving the range of motion in patients with shoulder impingement syndrome. [ABSTRACT FROM AUTHOR]

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ContextWhen playing handball, the preservation of the subacromial space, which can be quantified by the acromiohumeral distance (AHD), plays a crucial role for shoulder health of handball players. Acute effects of handball-specific loading on the subacromial space with consideration of individual adaptions resulting from long-term handball-specific loading experience have yet to be determined in order to prevent injuries such as e. g. an impingement of the supraspinatus tendon.ObjectiveTo (1) assess the acute effects of handball-specific loading on the AHD in healthy experienced handball players (HB) and non-handball experienced athletes (CG) and (2) to assess the AHD behavior in relation to individual intrinsic factors to identify possible risk factors and the effect of handball-specific experience associated adaptations.Participants20 HB (10m; 10f) and 20 CG (10m; 10f); 24 ± 5 years.InterventionHandball-specific loading protocol.Main outcome measuresThe AHD was measured by ultrasonography at 0° and 60° abduction pre and post intervention. Isometric shoulder strength was measured with hand-held dynamometry. Shoulder range of motion (ROM) was measured with goniometry.ResultsHandball-specific loading led to significantly reduced AHD in the dominant shoulder in the 60° abducted position in both groups (HB: −1.7 ± 2.0 mm; p = 0.001, d = 0.69; CG: −1.1 ± 2.0 mm; p = 0.024, d = 0.37) and in the non-dominant shoulder in 0° (−0.7 ± 1.5 mm; p = 0.038, d = 0.35) and 60° abducted position (−1.3 ± 1.8 mm; p = 0.004, d = 0.69) in HB only. Handball-specific loading enhanced AHD reduction when elevating the shoulder from 0° to 60° in both groups and arms. Larger shoulder abduction strength affected the maintenance of the AHD positively. HB demonstrated less shoulder strength compared to CG, while ROM did not differ.ConclusionsHandball-specific loading can affect the ability to preserve the subacromial space which might put handball players at risk for shoulder injuries. Poor shoulder strength can aggravate this mechanism. Therefore, implementation of strengthening exercises of the external rotator and abductor muscles in the training schedule may improve shoulder health of handball players.

Objective:The aim of the present study is to investigate the contribution of the coraco-acromial angle to the diagnosis of impingement syndrome.Method:The magnetic resonance images of the shoulder of 159 patients (96 females, 63 males) with impingement syndrome and 201 control cases (113 females, 88 males) from 2017 to 2019 were retrospectively evaluated. On the sagittal plane T2-weighted images, the shortest distances of humeral head to the acromion and the coracoid process, and the angle between longitudinal axis of the coraco-acromial ligament and longitudinal axis of the acromion were measured. To evaluate intra-observer reliability, all measurements were repeated two weeks later.Results:The mean values of coraco-humeral distance, acromio-humeral distance and coraco-acromial angle were 8.39±5.97 mm, 8.07±4.00 mm and 123.45±11.10°, respectively, in the patient group, and 10.32±2.52 mm, 10.69±2.19 mm and 124.75±6.95°, respectively, in the control group. While there was a significant difference between the patient and control groups in terms of coraco-humeral and acromio-humeral distances (p0.05). Elsewise, no correlation was found between impingement syndrome and coraco-acromial angle, since there were moderately negative correlations in terms of coraco-humeral and acromio-humeral distances.Conclusion:Unlike the coraco-humeral and acromio-humeral distances, there was no correlation between coraco-acromial angle and impingement syndrome.

Long-term friction of the FHL tendon's sheath (caused by sporting activities) can result in tendinitis, which causes pain in the foot and ankle and consequently interferes with everyday life and foot function. The FHL tendon is crucial for maintaining foot stability and can be damaged by overuse. FHL tendinitis can be also caused by inflammatory tendon sheath filled. Arthroscopy can play a role in the diagnosis and treatment of this condition. A 28-year-old female with left ankle pain was brought to our clinic after slipping on a train platform nine months ago. X-rays and MR imaging revealed a complete tear of the ATFL, minimal joint effusion, and a bony protrusion causing impingement. Arthroscopic surgery was performed, and the patient's pain sensation improved to 0–1 in the visual analogue scale (VAS) within three weeks. The Foot and Ankle Ability Measure (FAAM) score increased from 8 % to 100 %, and the patient was able to walk and perform daily activities normally. The FHL tendon sheath begins at the posterior tubercles of the talus and forms a fibroosseous tunnel along the medial calcaneus, potentially leading to impingement during ankle or hallux dorsiflexion. FHL tendon impingement and tendinitis share clinical manifestations, and if conservative treatments (NSAIDs, physical therapy) fail after 6 months, arthroscopic surgery is recommended for its minimally invasive benefits. Both arthroscopic and open surgical techniques yield positive outcomes for FHL pathologies; however, they carry risks such as neurovascular complications, highlighting the necessity for surgical precision and expertise. We concluded that in this case, FHL impingement was caused by the bony protrusion from Stieda process fragment. It was demonstrated that the arthroscopic surgery with loose body removal was successful and practical. • The Flexor Hallucis Longus (FHL) muscle originates from the interosseous membrane and the fibula, extending down to the great toe. • Overuse of the FHL tendon can lead to tendinitis, resulting in pain and reduced foot function. • FHL impingement syndrome is characterized by the muscle belly being too long, impacting the tendon sheath at the talus. • In cases where conservative methods have failed, surgical intervention has been associated with positive outcomes, notably the resolution of pain andnormal toe and ankle joint mobility, and a return to pre-injury levels of activity. • This case showed an FHL impingement caused by a bony protrusion from the Stieda process fragment, and arthroscopic surgery with removal of this loose body was effective in alleviating the patient's symptoms. [ABSTRACT FROM AUTHOR]

Background As nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids have similar effects, steroids can be avoided to reduce adverse effects. This study aimed to compare the differences in symptom improvement after subacromial injection of steroids or NSAIDs. Methods Sixty patients with rotator cuff syndrome for at least 3 months were enrolled and divided into steroid and NSAID groups. The steroid group received a mixture of 1 mL of triamcinolone acetonide (40 mg/mL) and 1 mL of lidocaine hydrochloride 2%, while the NSAID group received a mixture of 1 mL of Ketorolac Tromethamine (30 mg/mL) and 1 mL of lidocaine hydrochloride 2%. The patients were assessed before and at 3, 6, and 12 weeks after the procedure. Shoulder scores from visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), and University of California Los Angeles (UCLA) were used for evaluation. Results Both groups showed improvements in the clinical outcomes. Overall VAS, ASES, and UCLA scores improved from 6.9, 32.7, and 16.0 before the procedure to 2.0, 1.2, and 1.1; 81.5, 87.6, and 88.5; and 29.7, 31.8, and 32.0 at weeks 3, 6, and 12 weeks after the procedure, respectively. Twenty-six patients (86.7%) in the steroid group and 28 (93.3%) in the NSAID group reported satisfactory treatment outcomes. There were no significant differences in the outcomes between the two groups (p=0.671). Conclusions Subacromial injection of NSAIDs for rotator cuff tendinitis with shoulder pain had equivalent outcomes with those of steroid injection at the 12-week follow-up.

Abstract Backgrounds This study aimed to investigate the characteristic deformities of the hip in multiple hereditary exostoses patients (MHE) and its association with the hip impingement syndrome. Materials and methods Between 2001 and 2019, total 51 patients (102 hips) were evaluated in this study. Patients with MHE were classified to femoro-acetabular impingement (FAI) symptom group, ischio-femoral impingement (IFI) symptom group and non-impingement symptom group by comparing the symptoms, clinical signs and imaging studies. To assess the morphometry of the hip in patients with MHE, the femoral neck-shaft angle, Sharp’s acetabular angle and center-edge (CE) angle were evaluated. Alpha angle was further evaluated to investigate the FAI using radiographs, and the minimum ischio-femoral distance was further measured to investigate the IFI using computed-tomographic (CT) study. Results On hip impingement symptom analysis, FAI symptom and IFI symptom were confirmed in 14 hip joints and 18 hip joints, respectively. Unlike general population, the number of the hip with IFI-symptom was higher than those with FAI symptom in this study. In morphometric evaluation of MHE hips, coxa valga was most prominent deformity with occasional tendency of mild acetabular dysplasia. In a comparison of morphometric study between the impingement symptom group and non-symptom group, the FAI symptom showed significant differences of morphometric measure values than those of the non-symptom group (FAI symptom group vs. Non-FAI symptom group; Femoral neck-shaft angle (153.9 vs 142.6), Sharp’s angle (45.0 vs 41.5), CE angle (21.1 vs 28.8) and alpha angle (76.7 vs 57.9)). Similarly, the IFI symptom group also showed significant differences of morphometric measure values than those of the non-symptom group (IFI-symptom vs. Non-IFI symptom; Femoral neck-shaft angle (150.9 vs 142.7), Sharp’s angle (44.7 vs 41.4), CE angle (21.1 vs 29.3) and alpha angle (73.3 vs 56.8)). In addition, the minimum ischio-femoral distance measured using CT was significantly decreased in the IFI symptom group (IFI symptom group: 6.6, Non-IFI symptom group: 16.4). Conclusion The results suggest that the characteristic deformities represented by coxa valga in the MHE hip act as an offset for FAI symptoms, on the contrary, act as a trigger for IFI symptoms. Level of evidence Level III.

Introduction: Acromial morphology along with its position (slope/tilt) has a role in shoulder impingement. Acromioplasty is an important step in rotator cuff repair. Thus, knowledge of morphometric variations of the acromion is necessary. The aim of the study was to determine acromion morphometry and to correlate the morphometry of acromion with the dimensions of the scapula. Materials and Methods: The study was performed on 150 dried adult human scapulae, for which age and sex were not known. The shape of the acromion was observed from posterior and lateral view and different dimensions were measured. Results: The acromial curvature (as per Bigliani classification) was found to be flat (Category I) in 23.33%, curved (Category II) in 49.33%, and hooked (Category III) in 27.34% of scapulae. The acromial shape (from posterior view) was found to be quadrangular in 22%, triangular in 31.33%, and tubular in 46.67% of scapulae. The mean values of length, breadth, and thickness of acromion were 41.14 mm, 24.89 mm, and 6.95 mm, respectively. The acromion thickness was 8 mm in 12.67%. The mean of acromion slope and tilt were 28.23° and 42.47°, respectively. Conclusions: From the study, it may be concluded that a small proportion of the population (12.67%) may be prone to develop impingement due to more acromial thickness (>8 mm). The acromion slope and tilt are larger in our population which suggests lesser predisposition to impingement syndrome.

Purpose: This case-control study aimed at comparing the kyphosis angle, position of the shoulder, the strength of rotator cuff muscles, and the range of shoulder motions in volleyball players with and without impingement syndrome. Methods: The participants were 22 male professional volleyball players with at least 5 years of training experience. Eleven volleyball players with impingement syndrome and eleven without impingement syndrome were selected from accessible gyms by simple non-probabilistic sampling. The research tools were a flexible ruler, a measuring tape, a goniometer, a pull-up bar, a dynamometer, and tests to measure the distance between spinal midline and the shoulder, kyphosis angle, flexibility, range of motion, and isometric strength of the shoulder girdle muscles in abduction, adduction, flexion, extension, horizontal adduction, and horizontal abduction. Data were analyzed using SPSS V. 19 software and the Shapiro-Wilk test and independent t-test. Results: There was a significant difference between the two groups in terms of kyphosis angle, the distance between spinal midline and the shoulder, range of motion of the glenohumeral joint in abduction, and isometric strength of the shoulder girdle muscles in abduction, flexion, and extension (P0.01). Conclusion: The results of this study showed that angle of kyphosis, scapula distance to spine, range of motion of the shoulder, factor profile of a range of motion, and isometric muscle strength of shoulder girdle altered in people with shoulder impingement syndrome, and dysfunctions in these factors may result in shoulder impingement syndrome and athlete performance inefficiency.

This literature review provides a range of neurological and other organic causes of brachialgia. Features of pain syndrome in different medical conditions are described.

INTRODUCTION[|]The aim of this study was to evaluate the coexistence of C5 and/or C6 root compression with rotator cuff pathologies and its effect on pain and disability.[¤]METHODS[|]A total of 65 patients with pain radiating from neck to shoulder were retrospectively evaluated on the basis of demographic data, duration of symptoms, overhead activities, and physical examination. The visual numerical scale (VNS), Quick DASH (Disabilities of the Arm, Shoulder, and Hand), and Shoulder Pain and Disability Index (SPADI) were also used. Cervical magnetic resonance imaging (MRI) was used to evaluate C5–C6 root compression, which was separated into two groups as patients with or without upper trunk root compression (UTRC). These groups were compared according to the MRI findings of patients with rotator cuff pathologies.[¤]RESULTS[|]According to our results, C5 root compression (12.3%), C6 root compression (41.5%), UTRC (44.6%) were detected. There was no difference between the groups regarding the Hawkins and Neer tests. The Yergason and Jobe tests were statistically higher in patients without UTRC. In the shoulder MRIs, the rate of subscapular muscle tear was significantly higher in patients with UTRC. Other shoulder MRI findings were not different between the groups. VNS-neck and SPADI-pain scores were significantly higher in patients without UTRC. There was no difference between the groups in the scores of VNS-shoulder, Quick DASH, SPADI-disability, and SPADI-total.[¤]DISCUSSION AND CONCLUSION[|]Radiating pain from neck to shoulder that is caused by C5–C6 root compression does not create a predisposition for clinical, radiologic, and functional pathologies in shoulder joint. It seems difficult to diagnose the exact origin of pain in patients who present with neck pain radiating to shoulder based on the findings of cervical or shoulder MRI alone.[¤]

Objective:Rotator cuff tendon pathologies are the most frequently diagnosed disease group among the causes of shoulder pain. The aim of this study was to compare the results of platelet-rich plasma (PRP) and cortisone treatments applied to patients who admitted to our outpatient clinic with the diagnosis of Rotator cuff syndrome.Materials and Methods:A total of 40 patients with no shoulder movement restriction and shoulder pain longer than 3 months were included in the study. Pain symptoms of the patients were evaluated with Visual Analogue Scale (VAS) and functional status with the disabilities of the arm, shoulder and hand score (Quick-DASH).Results:Statistically significant improvements were observed in the VAS and Quick-DASH scores at the first and second month controls (according to the first month and pre-treatment) in the evaluations of the both groups (p

Background. Pathological changes in the size and structure of Hoffa’s fat pad can cause pain in the anterior section of the knee joint. Therefore, they should be diagnosed. The objective of the paper is to improve the diagnostics of Hoffa’s fat pad disease on the basis of a detailed study of the clinical anatomy of the infrapatellar (Hoffa’s) fat pad and magnetic resonance imaging (MRI) findings in normal and pathological conditions.Materials and Methods. Protocols of 86 MRI examinations of knee joints with anterior knee pain syndrome and no clearly defined traumatic history nor positive clinical tests indicating damage to the intra-articular and periarticular elements with identified structural changes in the fat pad were selected retrospectively. The control group consisted of data from 24 examinations of asymptomatic knee joints. In all cases, the pathology was confirmed during diagnostic and therapeutic arthroscopy.Results. The MRI findings showed the normal structure of the infrapatellar fat pad, as well as pathological changes in the form of tearing, local edema, diffuse edema, synovial proliferation and fibrosis. Depending on the location and type of changes, 4 pathological syndromes were identified: “classic” Hoffa’s disease — 49 (57%) cases, infrapatellar synovial fold syndrome — 11 (13%), infrapatellar synovial fold separation syndrome — 6 (7%), and impingent syndrome of upper lateral adipose tissue — 20 (23%) cases.Conclusions. To identify a pathology, a precise synchronization of clinical and morphological changes is required. Accurate differentiation of syndromes is possible due to knowledge of the detailed anatomical and magnetic-resonance features of the fat pad in normal and pathological conditions. This allows to diagnose the cause of pain in the anterior sections of the knee joint, specify the diagnosis, and choose the optimal plan of treatment.

Introduction Subacromial impingement syndrome is considered to be one of the most common musculoskeletal disorders affecting the shoulder j’oint. The obj’ectives of the study were to find out the morphology of acromion process and the presence of enthesophytes in male and female scapulae. Methodology The study was done on 100 male and 100 female adult dry human scapulae of different people, collected from the Department of Anatomy, Kempe- gowda Institute of Medical Sciences, Bangalore. Acromial shapes were classified into 4 types—type I (flat), type II (curved), type III (hooked), and type IV (convex). Acromial spurs (enthesophytes), if any, in the anterior one-third of acromion was noted. Results The most common type of acromion found in both the sexes is type I. Even the enthesophytes were more commonly associated with type I acromion. The study revealed that the acromial shape of dried scapulae did not vary significantly with sex. Conclusion In the present study we could find the four types of acromion mentioned in the literature. Since acromial shapes influence the shoulder pathologies involving acromion, the knowledge on acromial morphology and enthesophytes aid the clinicians during its diagnoses and treatment (acromioplasty). Also, data on morphology of acromion could be used for forensic and anthropological purposes for determining gender, ethnicity, and so forth.

Purpose: To compare self-reported joint status, quality of life, level of activity and pain management in patients scheduled for surgical treatment of seven common ankle disorders: osteoarthritis (OA), primary osteochondral lesion of talus (P-OLT), recurrent osteochondral lesion of talus (R-OLT), lateral ankle instability (INST) and anterior (ANT-IMP), posterior (POST-IMP) and combined (COMB-IMP) ankle impingements. Methods: The cross-sectional study design was implemented. Hospital records of 610 patients that were admitted for surgical intervention on the ankle joint over a seven year period were reviewed. Patient selection (over 18 years, no systemic musculoskeletal illnesses, only one isolated ankle pathology) resulted in 123 eligible patients for current study (OA 22, P-OLT 19, R-OLT 18, INST 15, ANT-IMP 20, POST-IMP 13, COMB-IMP 16). Foot and Ankle Outcome Score (FAOS), European quality of life in a visual analogue and in five dimensions (EQ-VAS, EQ-5D-3L), Tegner activity scale (TAS) and pain medication usage were recorded at the admission and compared across these seven groups. Results: All evaluated ankle disorders induced the following: (a) subjective joint-specific dysfunction - FAOS cumulative: 42 (OA), 50 (R-OLT), 65 (P-OLT), 65 (INST), 63 (ANT-IMP), 61 (POST-IMP), 60 (COMB-IMP); (b) decreased quality of life - EQ-5D-3L: 0.41 (OA), 0.44 (R-OLT), 0.56 (P-OLT), 0.62 (INST), 0.64 (ANT-IMP), 0.56 (POST-IMP), 0.60 (COMB-IMP) and (c) decreased activity level - TAS: 2.1 (OA), 2.7 (R-OLT), 3.7 (P-OLT), 4.0 (INST), 4.7 (ANT-IMP), 4.4 (POST-IMP), 5.1 (COMB-IMP). FAOS subscales, EQ-5D-3L and TAS were significantly lower in OA and R-OLT patients. Between 31% (POST-IMP) and 68% (OA and R-OLT) of patients required pain medication over one month prior to the assessment. Conclusion: All analysed ankle disorders in patients amenable for surgical treatment induced a considerable decline in patients' perceived ankle function, quality of life and activity level. The worst subjective ankle status was reported equally by OA and R-OLT patients, while patients with the other five disorders reported comparable values. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the effects of a combination of dry needling (DN) and muscle energy technique (MET) on pain intensity (PI), pressure pain threshold (PPT) and shoulder active range of motion (ROM) in patients with shoulder impingement syndrome and active trigger points in the infraspinatus muscle. 39 patients, aged 20–50 participated in this study. All the cases were randomly assigned into three groups: group 1 (n = 13) received DN, group 2 (n = 13) received MET, and group 3 (n = 13) received DN & MET. The patients were treated for three sessions in a one-week period with at least a two-day break between sessions. The results showed a significant improvement in visual analog scale (VAS), PPT and shoulder ROM over time (P < 0.001) in all three groups. There were no significant differences BETWEEN VAS (P = 0.406) PPT (P = 0.293), external rotation(EXT.ROT) (0.476), internal rotation (INT.ROT)(P = 0.476) and extension(EXT) (P = 0.574) ROMs in the three groups; however, DN group was significantly more effective on abduction(ABD) (P = 0.003) and flexion(FLEX) (0.012) ROM compared with other two groups. In line with previous studies, the present study found that the application of DN, MET and combined of these treatment on active trigger points in the infraspinatus muscle of patients with shoulder impingement syndrome helps reduce pain, increase PPT and enhance the shoulder ROM. Both techniques are effective in the treatment of trigger points. Nevertheless, DN is more effective in enhancing the ROM of flexion & abduction. [ABSTRACT FROM AUTHOR]

Copyright of Bagcilar Medical Bulletin / Bağcılar Tıp Bülteni is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: As nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids have similar effects, steroids can be avoided to reduce adverse effects. This study aimed to compare the differences in symptom improvement after subacromial injection of steroids or NSAIDs. Methods: Sixty patients with rotator cuff syndrome for at least 3 months were enrolled and divided into steroid and NSAID groups. The steroid group received a mixture of 1 mL of triamcinolone acetonide (40 mg/mL) and 1 mL of lidocaine hydrochloride 2%, while the NSAID group received a mixture of 1 mL of Ketorolac Tromethamine (30 mg/mL) and 1 mL of lidocaine hydrochloride 2%. The patients were assessed before and at 3, 6, and 12 weeks after the procedure. Shoulder scores from visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), and University of California Los Angeles (UCLA) were used for evaluation. Results: Both groups showed improvements in the clinical outcomes. Overall VAS, ASES, and UCLA scores improved from 6.9, 32.7, and 16.0 before the procedure to 2.0, 1.2, and 1.1; 81.5, 87.6, and 88.5; and 29.7, 31.8, and 32.0 at weeks 3, 6, and 12 weeks after the procedure, respectively. Twenty-six patients (86.7%) in the steroid group and 28 (93.3%) in the NSAID group reported satisfactory treatment outcomes. There were no significant differences in the outcomes between the two groups (p=0.671). Conclusions: Subacromial injection of NSAIDs for rotator cuff tendinitis with shoulder pain had equivalent outcomes with those of steroid injection at the 12-week follow-up. [ABSTRACT FROM AUTHOR]