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Background: Several tests have been suggested for screening and diagnosis of cervical spine and shoulder girdle conditions underlying shoulder pain with variable degrees of clinical accuracy. The present study aimed to test the reliability, clinical benefit and screening value of the Swimmer Arm-to-Shoulder (SAS) test; a new clinical test developed to differentiate shoulder impingement from cervical radiculopathy in patients with shoulder pain of ≤ 12 weeks., Methods: The study included 718 patients aged 40-65 years, with unilateral and localized shoulder girdle pain lasting for ≤ 12 weeks. Diagnosis based on clinical, electromyography and radiological findings was considered as the reference gold standard for test assessment., Results: Clinical diagnosis identified shoulder pathology in 288 patients (40.1%) and cervical spine pathology in 430 patients (59.9%). SAS test was positive in 274 patients (38.2%). The SAS test proved to be effective in distinguishing shoulder from cervical spine pathology with a sensitivity of 89.2% (95% CI: 85.0-92.6%), specificity of 96.1% (95% CI: 93.8-97.7%), PPV of 93.8% (95% CI: 90.5-96.0%), NPV of 93.0% (95% CI: 90.5-94.9%), LR + of 22.6% (95% CI: 14.1-36.0%), LR- of 0.11 (95% CI: 0.08-0.16) and accuracy of 93.3% (95% CI: 91.2-95.0%)., Conclusions: SAS test is an easy to perform, patient dependent and reliable as a screening test and diagnosis confirmatory test., Competing Interests: Declarations. Ethics approval and consent to participate: Protocol of the present study was approved by the ethical committee of Al-Azhar Faculty of Medicine and all participants provided informed consent in accordance with the Helsinki Declaration on clinical research involving human subjects. Consent for publication: NA. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

A man in his early 50s presented with mechanical chronic pain and limitation of the active range of motion of the right shoulder. Imaging of the shoulder showed osteophytosis without joint space narrowing or cranial migration of the humeral head. He reported no history of trauma, dislocation arthropathy, clinical or standard biological evidence for septic or inflammatory arthritis, metabolic, haemophilic or endocrine-associated arthropathies. The second medical consultation revealed enlargement and infiltration of hands and feet. Consequently, we suspected acromegaly, which was confirmed by endocrinological diagnosis. Further, an MRI of the pituitary gland showed a sellar tumour. The patient's shoulder pain was related to undiagnosed acromegalic arthropathy leading to osteoarthritis and was treated by trans-sphenoidal exeresis of the somatotroph adenoma and a somatostatin analogue. In conclusion, acromegaly should be considered in patients with centred glenohumeral osteoarthritis, as an early diagnosis is essential to limit complications and preserve the quality of life., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Subacromial balloon spacer implantation (SBSI) attempts to decrease glenohumeral joint (GHJ) pain and improve function in patients with an irreparable rotator cuff tear (RCT) and minimal osteoarthritis. Between 12 and 26 weeks post-SBSI, gradual implant resorption may create a "balloon dip" that decreases GHJ function and increases pain. This retrospective cohort study attempted to delineate shoulder function, active mobility, strength, pain, and functional task impairment during the "balloon dip" period., Materials and Methods: Sixty-five consecutive patients (55.9 ± 7 years of age, 42 men) with an irreparable RCT treated by the same fellowship-trained shoulder surgeon participated in this study. Outcome measurements pre-SBSI, during Phase I (early pain control ≤ 3 weeks post-SBSI), Phase II (early rehabilitation > 3-11 weeks post-SBSI), Phase III (advanced rehabilitation-early balloon resorption > 11-16 weeks post-SBSI), Phase IV (early strength training > 16-24 weeks post-SBSI), and Phase V (advanced strength training > 24 weeks post-SBSI) included the American Shoulder and Elbow Society (ASES) score for perceived bilateral shoulder function, visual analog scale (VAS) surgical shoulder pain score, active mobility, and shoulder manual muscle strength testing (p ≤ 0.05)., Results: The mean final follow-up time was 40 weeks (range = 24.1-89.7 weeks). The surgical shoulder had higher ASES scores at Phase V than pre-SBSI. Surgical shoulder pain was less during Phase V than pre-SBSI. The surgical shoulder had greater flexion during Phase V than at Phase II or pre-SBSI, and greater external rotation (adducted) during Phases V-III than pre-SBSI. Peak shoulder internal rotation to level 12 (thoracic spinous process #10) occurred during Phase V. Peak shoulder flexor, external rotator, and internal rotator strength occurred during Phase V. During Phase I, most subjects were unable to sleep on their surgical shoulder, wash their back/do up their bra, reach a high shelf, or lift 10-lbs overhead. Tasks that were impaired during the "balloon dip" (between Phase III and V) were lifting 10-lbs overhead, reaching a high shelf, and doing normal work. By the end of Phase V, however, most subjects could perform each task with minimal or no difficulty., Conclusion: Surgical shoulder function improved and pain decreased, however, specific perceived functional task impairments remained. During the "balloon dip" phase, the perceived ability to lift 10 lbs above shoulder level, to reach a high shelf, and to do usual work activities were the most impaired tasks., Competing Interests: Declarations Conflict of interest Dr. Ryan Krupp is a consultant for Stryker Corporation. The other authors did not have any conflicts of interest to report in association with the current study. Ethics approval This study was approved by the Norton Healthcare Medical Institutional Review Board. Informed consent All subjects provided written informed consent., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Objective: The aim of the study was to evaluate determinants of between-person variation in shoulder pain ("yes"/"no") in individuals with spinal cord injury living in Switzerland., Design: This longitudinal study used data from the Swiss Spinal Cord Injury Cohort community surveys 2012, 2017, and 2022. Logistic regression analyses were used to identify determinants of between-person variability in shoulder pain while controlling for within-person variability., Results: The prevalence of shoulder pain was 34.4% (95% CI = 33.0-35.9) when studying 4393 completed questionnaires. Significant determinants for between-subject variability revealed higher likelihoods for shoulder pain in females as compared with males (odds ratio: 1.57; 95% CI = 1.21-2.05), and when spasticity (1.49; 1.14-1.95), contractures (2.77; 2.21-3.48), and depression (1.39; 1.02-3.48) were present. In addition, shoulder pain presented highest likelihoods in individuals with incomplete tetraplegia (1.81; 1.32-2.48) versus incomplete paraplegia, in individuals over 26 yrs since injury (1.65; 1.15-2.37) versus up to 5 yrs since injury, and in individuals using a manual (2.17; 1.53-3.08) or electrical (2.16; 1.41-3.31) wheelchair versus no aids. There were significant interaction effects for gender with time since injury, contractures, and depression., Conclusions: Determinants of between-subject variability in shoulder pain were female gender, lesion severity, time since injury, specific health conditions, and wheelchair use., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: The aim of the study is to investigate the association between adherence to spinal cord injury-specific physical activity guidelines in manual wheelchair users with spinal cord injury and shoulder pain prevalence., Design: This is a cross-sectional analysis of the SwiSCI Community Survey 2022 data, assessing aerobic activity and muscle strength training adherence in manual wheelchair users with spinal cord injury and shoulder pain prevalence. Logistic regression analysis was used to identify the association between meeting the physical activity guidelines and shoulder pain., Results: Low adherence to aerobic activity and strength training guidelines are observed, with 46% and 64% of the study sample not meeting the respective guidelines. The low adherence to physical activity guidelines contrasts with the general Swiss population from which around 75% is physically active for more than 2.5 hrs a week. Manual wheelchair users present a high prevalence of shoulder pain (40%) and nonadherence to aerobic guidelines in the study sample correlates with 1.55-1.97 higher odds of having shoulder pain., Conclusions: Aerobic activity adherence is associated with lower shoulder pain prevalence, emphasizing its potential for injury prevention. Overall, the presented findings necessitate further longitudinal studies and interventions for a comprehensive understanding and effective management of shoulder pain in manual wheelchair users with spinal cord injury., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The presence of subjective mechanical symptoms, such as clicking or popping, is common in patients presenting for shoulder pain and dysfunction, with unclear clinical significance. The primary objective of this study was to assess whether subjective mechanical symptoms in the affected shoulder were associated with full-thickness rotator cuff tearing in a consecutive, prospective cohort of patients undergoing shoulder magnetic resonance imaging (MRI) for suspected rotator cuff pathology., Methods: A prospective cohort study was performed of 100 consecutive patients with suspected rotator cuff tendinopathy and/or tearing who underwent shoulder MRI. The presence of subjective shoulder mechanical symptoms, including clicking or popping, was documented prior to MRI. Indications for MRI included weakness on isolated testing of rotator cuff muscle(s) or symptoms refractory to conservative treatment including at least a 6-week course of physical therapy. The primary outcome variable was the presence of full-thickness rotator cuff tearing; secondary outcome variables included any (full-thickness or partial-thickness) rotator cuff tearing and biceps long head subluxation. Radiographic parameters, including critical shoulder angle, Goutallier grade, tear retraction, and tear size were quantified. One patient was lost to follow-up, and 99 patients completed MRI imaging., Results: In our cohort, 60% of patients reported subjective mechanical symptoms in the affected shoulder. Full-thickness rotator cuff tearing was identified in 42% of patients, any rotator cuff tearing in 69% of patients, and biceps long head subluxation in 14% of patients. Subjective mechanical symptoms were not associated with full-thickness rotator cuff tearing, any rotator cuff tearing, biceps long head subluxation, critical shoulder angle, Goutallier grade, tear size, or tear retraction. Older age was associated with full-thickness and any rotator cuff tearing. As a diagnostic test for full-thickness rotator cuff tearing, subjective shoulder mechanical symptoms has a sensitivity of 64%, a specificity of 44%, and Youden's index of 0.08, consistent with poor diagnostic accuracy., Conclusions: Subjective mechanical symptoms in the affected shoulder are a common complaint in patients with suspected rotator cuff pathology. Patients may be reassured that a sensation of clicking or popping alone does not necessarily entail structural shoulder derangement., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Introduction: Chronic shoulder pain is highly prevalent in the general population. Many different analgesic strategies have been described, including radiofrequency treatment to the suprascapular nerve (RFS); however, the effectiveness this approach remains unclear, and no strong recommendation can be made. The aim of this systematic review is to analyse the latest clinical trials evaluating the effectiveness of RFS techniques applied to the suprascapular nerve in terms of management of chronic shoulder pain, post-procedural functionality, and adverse effects., Methods: We performed a systematic review of clinical trials retrieved from Medline, Embase and the CENTRAL databases. We included trials comparing RFS with other strategies, including placebo, that had as their primary outcome measures pain rated on a visual analogue scale, functionality rated on a shoulder pain and disability index (SPADI), and the incidence of adverse events. Risk of bias was analysed using the Cochrane RoB2 tool. Evidence was analysed using a random effects model and heterogeneity was quantified using the I 2 test., Results: We identified 3030 trials, of which 8 met the inclusion criteria (n = 408). Seven had a high risk of bias. Pain intensity at 1 and 3 months was lower in patients receiving RFS, with a standardised mean difference (SMD) of -0.9 (95% CI [-1.1, 0.33], p = 0.29; I 2 88%, p < 0.001) and -1.17 (95% CI [-2.49, 0.14], p = 0.08; I 2 97%, p < 0.001), respectively. Functional compromise at 1 and 3 months decreased in patients receiving RFS, with an SMD of -0.31 (95% CI [-0.91, 0.29], p = 0.31; I 2 80%, p < 0.001) and -1.54 (95% CI [-3.26, 0.19], p = 0.08; I 2 98%, p < 0.001), respectively. No RFS-related adverse events were described., Conclusion: The evidence suggests that RFS reduces pain and improves functionality. However, the certainty of the evidence is low., (Copyright © 2024 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Poststroke shoulder pain (PSSP) is a common poststroke complication. Even though it is a common phenomenon, it is unclear how it impacts the patient's life., Objective: To investigate the differences in upper extremity function, sleep quality, and functional independence between patients with and without PSSP., Methods: This cross-sectional study included 63 participants with stroke (32 patients with PSSP and 31 patients without PSSP). Shoulder pain was evaluated with a Visual Analog Scale and the participants were divided into two groups as those with and without PSSP. The upper extremity function was assessed with the Disabilities of the Arm, Shoulder, and Hand Questionnaire, the Arm Motor Ability Test, and the Nine Hole Peg Test. Sleep quality was assessed with Pittsburgh Sleep Quality Index and the functional independence was assessed with the Functional Independence Measure. All data were analyzed using the program IBM SPSS Statistics 22.0. The Mann-Whitney U test was used to compare the non-normally distributed parameters, and the Chi-square test was used to compare the ordinal variables. The Spearman correlation test was used for the relationship and a linear regression test was used for regression., Results: Upper extremity function decreased ( p  < .05), only the sleep disturbance sub-parameter of sleep quality increased ( p  = .01), and functional independence increased in patients with PSSP ( p  < .001). There was a moderate relationship between pain and upper extremity function and a fair relationship between pain and sleep quality (use of sleep medications, daytime dysfunction sub-parameters) ( p  < .05)., Conclusions: PSSP impairs upper extremity functions, which play an important role in activities of daily living, and reduces functional independence. These results suggest that it is important to evaluate shoulder pain and examine the factors affecting pain in the rehabilitation of patients with stroke.

The prevalence of asymptomatic shoulder pathology has been shown to be high on both ultrasound and magnetic resonance imaging (MRI). The most common shoulder pathologies identified in asymptomatic, non-athlete individuals include rotator cuff pathology, acromioclavicular (AC) joint pathology, labral tears, subacromial bursitis, and calcific tendinitis. The data in the current literature suggest that asymptomatic rotator cuff tears are diagnosed on ultrasound and MRI at high rates, suggesting that rotator cuff tears may be considered an age-related, normal, degenerative change. However, there are data to suggest that the presence of an asymptomatic rotator cuff tear on imaging may predispose a patient to shoulder pain in the future, although the data remain inconclusive. AC joint arthritic changes are also common in older individuals on advanced imaging. Recent studies have reported that labral tears are common in asymptomatic shoulders, although at less frequent rates than in athletes, but more research is required on this topic. In addition, the presence of subacromial bursitis on imaging has not been found to accurately differentiate between symptomatic and asymptomatic shoulders. Finally, calcific tendinitis has been diagnosed asymptomatically, with most individuals remaining asymptomatic. Individuals who did develop pain developed severe pain, although the risk factors for developing symptomatic calcific tendinitis are unclear. In summary, given the high prevalence of shoulder pathology diagnosed on imaging, it is important to not over diagnose or complete an unnecessary workup for an asymptomatic person who is otherwise healthy., (© 2024 American Academy of Physical Medicine and Rehabilitation.)

Background: Spontaneous shoulder-girdle pain and scapular winging/dyskinesis can be caused by several neuromuscular disorders identifiable by electrodiagnostic studies (EDX). We describe a group of adolescent athletes with this clinical presentation but normal EDX, followed by later development of neurogenic thoracic outlet syndrome (NTOS)., Methods: We identified patients referred for evaluation of NTOS that had a history of chronic atraumatic shoulder-girdle pain, scapular winging/dyskinesis, and normal EDX. Each was refractory to conservative management and underwent supraclavicular decompression and brachial plexus neurolysis for NTOS. Functional disability was quantified by Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores., Results: There were 5 female patients with a mean age at symptom onset of 14.2 ± 0.4 years, including spontaneous severe pain in the shoulder, scapula, and arm, along with prominent scapular winging/dyskinesis, and normal EDX. Symptoms had persisted for 18.9 ± 4.0 months prior to referral, with pronounced upper extremity disability (mean QuickDASH, 54.6 ± 6.9). By 3 months after surgical treatment for NTOS, all 5 patients experienced near-complete symptom resolution, including scapular winging/dyskinesis, with markedly improved function (mean QuickDASH, 2.2 ± 1.3) and a return to normal activity., Conclusions: A subset of patients with chronic atraumatic shoulder-girdle pain, scapular winging/dyskinesis, and normal EDX may develop dynamic brachial plexus compression characteristic of NTOS, exhibiting an ischemic "Sunderland-zero" nerve conduction block for which surgical decompression can result in rapid and substantial clinical improvement. The presence of surgically treatable NTOS should be considered for selected patients with long-standing scapular winging/dyskinesis who fail conservative management., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Rationale: Shoulder pain is a common type of musculoskeletal pain. While musculoskeletal issues are primary causes of shoulder pain, it is important to note that referred pain in the shoulder area can also originate from non-musculoskeletal problems., Patient Concerns: A 60-year-old male presented with a month-long stabbing pain in the right shoulder that was worsened by deep breathing. He had no trauma history or neurological symptoms. He also experienced a 5 kg weight loss over 3 months. Physical examination was normal. Shoulder X-ray suggested degenerative arthritis. Despite medication including opioids, his pain persisted and worsened to a 10/10 severity, spreading to the right flank and anterior chest., Diagnosis: An abdominal CT scan revealed multiple hepatic nodules, ascites, and right pleural effusion, suggesting a systemic condition., Interventions: This prompted immediate referral to oncology, where subsequent investigations confirmed the diagnosis of intrahepatic cholangiocarcinoma., Outcomes: The patient deteriorated and passed away during the buildup phase for cancer treatment., Lessons: This case underscores the importance of considering systemic conditions in patients presenting with seemingly localized symptoms such as shoulder pain. It highlights the significance of thorough evaluation and prompt referral for further investigations when necessary., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Parsonage-Turner syndrome following monkeypox infection is a rare form of peripheral neuropathy seen in orthopaedic practice and described only once in the literature. We present the case of a man in his 30s with severe shoulder pain and subsequent amyotrophy 2 weeks after monkeypox infection. Our report encompasses the initial findings, radiographic examinations and follow-up over a 6-month period. To confirm the diagnosis, MRI and electrostimulation conduction studies were conducted, highlighting their importance as valuable diagnostic tools in conjunction with a thorough physical examination. Supportive treatment, including physical therapy and pain management, forms the cornerstone of management, while surgical intervention is reserved for refractory cases or when mechanical complications arise. Prognosis varies among individuals. This case report expands the understanding of neurological complications of monkeypox infection. Clinicians should include Parsonage-Turner syndrome in their differential diagnosis for patients presenting with symptoms of peripheral brachial plexus neuropathy following viral infections, including monkeypox., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: To assess the effectiveness of intraoperative lidocaine in reducing the incidence of post-laparoscopic shoulder pain (PLSP) after gynecologic laparoscopy., Methods: Patients undergoing total laparoscopic hysterectomy were randomly divided into two groups: the lidocaine group, receiving an initial intravenous dose of lidocaine (1.5 mg/kg) before anesthesia induction, followed by a continuous infusion at 2 mg/kg/h, and the placebo group, receiving saline. The primary endpoint was the determination of PLSP incidence over a 72-h period post-surgery. Secondary endpoints included a comprehensive evaluation of pain intensity, as measured by the Numeric Rating Scale (NRS), for shoulder, abdominal, and incisional pain within a 72-hour period postoperatively. Additionally, the endpoints involved the assessment of Lofencodeine or Parexib Sodium usage frequency, incidence of nausea and vomiting, duration of anesthesia and surgical procedure, as well as the duration of hospital stay., Results: Our study did not demonstrate any significant benefit in the incidence of PLSP during the postoperative period. PLSP occurred in 14 out of 41 patients (34.1%) in the lidocaine group, compared with 15 out of 41 patients (36.6%) in the placebo group (p = 0.817). Intravenous lidocaine reduced abdominal pain scores and decreased the need for postoperative analgesics within 72 h after surgery. No significant differences were found in incisional and shoulder pain intensity, nausea and vomiting rates, or hospitalization duration between groups., Conclusions: The infusion of lidocaine did not yield a reduction in the incidence or severity of PLSP in patients undergoing laparoscopic total hysterectomy., (© 2024 Japan Society of Obstetrics and Gynecology.)

Objective: The objective of this study was to study the recovery from, and incidence of, work-restricting musculoskeletal pain after bariatric surgery compared with usual obesity care., Methods: Pain in different body regions was monitored using questionnaires in the nonrandomized, prospective, controlled Swedish Obese Subjects (SOS) study, which included 2007 participants treated with bariatric surgery and a matched control group of 2040 participants receiving usual obesity care at primary health care centers. Self-reported pain in the neck and shoulders, back, hips, knees, and ankles was captured from questionnaires administered at baseline and after 1, 2, 3, 4, 6, 8, 10, 15, and 20 years., Results: Compared with matched controls, bariatric surgery was associated with better recovery from baseline work-restricting knee and ankle pain in both the short (1-4 years) and long term (up to 20 years), as well as from back and hip pain in the short term. In participants without pain at baseline, bariatric surgery was associated with a lower incidence of developing new pain in the knee and ankle in the short and long term., Conclusions: Bariatric surgery was associated with better recovery from pain, primarily in weight-bearing joints, as well as with prevention of pain development in the knee and ankle compared with matched controls receiving usual obesity care., (© 2024 The Author(s). Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.)

Abstract: Pediatric acquired and congenital conditions leading to shoulder pain and dysfunction are common. Objective, quantitative musculoskeletal imaging-based measures of shoulder health in children lag recent developments in adults. We review promising applications of quantitative imaging that tend to be available for common pediatric shoulder pathologies, especially brachial plexus birth palsy and recurrent shoulder instability, and imaging-related considerations of musculoskeletal growth and development of the shoulder. We highlight the status of quantitative imaging practices for the pediatric shoulder and highlight gaps where better care may be provided with advances in imaging technique and/or technology., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Rotator cuff calcific tendinitis (RCCT) is a common shoulder disease whose main symptoms include shoulder pain, limited mobility, and calcification deposits in the shoulder. Traditional treatment methods have certain limitations, so finding new treatment methods has become the focus of research. Extracorporeal shock wave (ESW) and platelet-rich plasma (PRP) treatments have attracted much attention due to their non-invasive and tissue repair-promoting properties; however, the efficacy of their combined treatment in RCCT remains unclear., Methods: This study is designed as a single-center, assessment-blind, randomized controlled clinical trial with three parallel groups. Sixty subjects will be recruited and randomly divided into the ESW group, PRP group, and ESW combined with PRP group, in a 1:1:1 ratio. The entire intervention period is 4 weeks, and the follow-up period is 4 weeks. Outcomes will be measured at baseline (T0), after 1 week of intervention (T1), after 2 weeks of intervention (T2), after 4 weeks of intervention (T3), and after an additional 4 weeks of follow-up period (T4). The primary endpoint is the VAS score. Secondary endpoints are ASES, CMS, UCLA, and the location and size of calcified areas., Discussion: This study aims to evaluate the efficacy of ESW therapy combined with PRP in treating RCCT. We compare the effects of single and combined treatments to explore their impact on disease symptoms, functional improvement, and calcification regression. This provides a scientific basis for identifying more effective treatment options., Trial Registration: ClinicalTrials.gov NCT06372600. Registered on April 17, 2024; version 1., (© 2024. The Author(s).)

Background: Shoulder impingement syndrome (SIS) is a common condition that causes chronic shoulder pain. The effectiveness of acupuncture in treating chronic shoulder pain has been documented in previous studies; however, existing systematic reviews and meta-analyses have often excluded Chinese databases and combined different types of acupuncture interventions, such as electroacupuncture, warm acupuncture, pharmacopuncture, and acupotomy. Thus, this study specifically examines the exclusive impact of manual acupuncture on SIS., Methods: Several databases, including PubMed, Cochrane Central, Embase, 1 Chinese database (China National Knowledge Infrastructure), and 5 Korean databases (ScienceON, Oriental Medicine Advanced Searching Integrated System, KoreaMed, Korean Studies Information Service System, and KMBASE), were systematically searched for relevant studies. The quality of the included studies was evaluated using the Cochrane Assessment Tool for Risk of Bias Version 2. Data collected from the selected studies were synthesized for meta-analysis. The primary outcome was a pain scale score, and the secondary outcomes were shoulder function and disability., Results: This study included 5 randomized controlled trials. The primary outcome assessment revealed significantly reduced pain (standardized mean difference [SMD] = -0.50, 95% confidence interval [CI] = -0.74 to -0.27) and improvements in shoulder function and disability (SMD = -0.57, 95% CI = -0.96 to -0.19). A subgroup analysis based on treatment duration indicated that short-term acupuncture treatment (≤4 weeks) exhibited a high level of confidence with low heterogeneity (SMD = -0.37, 95% CI = -0.73 to -0.02)., Conclusion: Manual acupuncture is effective for relieving pain and improving shoulder function and disability in patients with SIS. However, further research is necessary to validate these findings owing to the limited number of patients and heterogeneity among the studies reviewed., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background and Objectives: Postoperative shoulder pain is a common issue after total laparoscopic hysterectomy (TLH). This study evaluated the impact of a shoulder movement routine on postoperative shoulder pain in women undergoing uncomplicated TLH. Materials and Methods: An open-label randomized clinical trial included women without prior shoulder pain undergoing TLH between 20 January and 20 March 2024. Participants were randomized into two groups: Group 1 ( n = 36) received a shoulder movement routine, while Group 2 (control, n = 39) performed a hand movement routine. Shoulder pain was assessed using the visual analog scale (VAS) at 6 h, 24 h, and 7 days postoperatively. Results: Seventy-five women participated. No significant differences were found between the groups regarding demographic variables, surgery duration, or hospital stay. Shoulder pain scores (VAS) at three time points (6 h, 24 h, and 7 days) showed no significant differences between groups ( p = 0.57, p = 0.69, and p = 0.91, respectively). Similarly, there were no significant differences in incisional or abdominal pain. Conclusions: The shoulder movement routine did not significantly reduce postoperative shoulder pain in women undergoing uncomplicated TLH.

Introduction: Poststroke shoulder pain is a common complication that severely affects the recovery of upper limb motor function. Acupuncture has positive analgesic effects in treating poststroke shoulder pain, and studies have demonstrated the efficacy of transcranial direct current stimulation (tDCS) in treating patients with this pain. However, whether acupuncture combined with tDCS has a superior rehabilitation effect on poststroke shoulder pain is currently unknown. We aimed to observe the effect of the combined intervention on poststroke shoulder pain and explore its possible central analgesic mechanism., Methods and Analysis: This study describes a randomised controlled trial using assessor blinding. A total of 135 poststroke patients with shoulder pain will be randomly assigned in a 1:1:1 ratio to the tDCS group, acupuncture group and combined group (acupuncture plus tDCS). All three groups will undergo conventional rehabilitation treatment. Participants in the tDCS group will receive tDCS stimulation on the M1 area for 20 min, while the acupuncture group will receive 20 min of acupuncture. The combined treatment group will receive both. All treatments will be performed five times per week for 4 weeks. The primary outcome indicator in this study is the Visual Analogue Scale pain score. Secondary outcome indicators include shoulder mobility, Shoulder Pain and Disability Index, Fugl-Meyer Motor Function Scale, Modified Barthel Index Scale, Self-Rating Anxiety and Depression Scale and functional MRI. All scale results will be assessed at baseline and at 2 weeks and 4 weeks, and during follow-up at 1 month, 3 months and 6 months postdischarge. A repeated analysis of variance will be conducted to observe the group×time interaction effects of the combined intervention. Moreover, functional MRI will be applied to explore the central analgesic mechanism., Ethics and Dissemination: Ethics approval was obtained from the Ethics Committee of the Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine (2023KY-039-001). The results of the study will be published in a peer-reviewed journal and presented at scientific conferences., Trial Registration Number: ChiCTR2300078270., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To systematically review the clinical efficacy (pain, function, quality of life) and safety of platelet-rich plasma (PRP) in the treatment of frozen shoulder through meta-analysis, and provide evidence-based medical evidence for the effectiveness of PRP in the treatment of frozen shoulder., Methods: A search was conducted on international databases (Pubmed, Web of science, Embase) and Chinese databases (CNKI, Wanfang, VIP) to search the clinical studies on the efficacy of platelet-rich plasma in treating frozen shoulder (adhesive capsulitis/periarthritis/50 shoulder) and their corresponding references published from inception until January 2024. Thoroughly excluded literature not meeting the predetermined inclusion criteria, extracted relevant data from the literature, and input it into RevMan5.4 for meta-analysis., Results: This study ultimately included 14 RCTs, with a total of 1024 patients. The results showed that PRP has significant advantages compared with control groups in VAS (mean difference (MD) =-0.38, 95% confidence interval(CI)(-0.73, -0.03), P = 0.03), UCLA (MD = 3.31, 95% CI (1.02,5.60),P = 0.005), DASH (MD = -4.94,95% CI (-9.34, -0.53),P = 0.03), SPADI (SPADI Total: MD =-16.87, 95% CI (-22.84, -10.91), P < 0.00001; SPADI Pain: MD =-5.38, 95% CI (-7.80, -2.97), P < 0.0001; SPADI Disability: MD =-11.00, 95% CI (-13.61,-8.39), P < 0.00001), and the active and passive Range of Motion (active flexion: MD = 12.70, 95% CI (7.44, 17.95), P < 0.00001; passive flexion: MD = 9.47, 95% CI(3.80, 15.14), P = 0.001; active extension: MD = 3.45, 95% CI(2.39, 4.50), P < 0.00001; active abduction: MD = 13.54, 95% CI(8.42, 18.67), P < 0.00001; passive abduction: MD = 14.26, 95% CI (5.97, 22.56), P = 0.0008; active internal rotation: MD = 5.16, 95% CI (1.84, 8.48), P = 0.002; passive internal rotation: MD = 3.65, 95% CI(1.15, 6.15), P = 0.004; active external rotation: MD = 10.50, 95% CI(5.47, 15.53), P < 0.0001; passive external rotation: MD = 6.00, 95% CI (1.82, 10.19), P = 0.005) except passive extension (MD = 2.25, 95% CI (-0.77, 5.28), P = 0.14). In terms of safety, most studies reported no adverse effects, and only one study reported common complications of joint puncture such as swelling and pain after treatment in both PRP and control groups. Previous studies have shown a risk of osteonecrosis caused by corticosteroids. Therefore, the safety of PRP treatment is more reliable., Conclusion: The results showed that PRP was more durable and safer than corticosteroids and other control groups in the treatment of frozen shoulder., Study Design: Systematic review., Trial Registration: PROSPERO CRD42022359444, date of registration: 22-09-2022., (© 2024. The Author(s).)

Background: Given the high prevalence of chronic shoulder pain and encouraging early results of terminal sensory articular branch radiofrequency ablation to treat shoulder pain, research is warranted to refine the procedural technique on the basis of updated neuroanatomic knowledge with the goal of further improving patient outcomes., Objective: We describe an updated radiofrequency ablation protocol that accounts for varied locations of the terminal sensory articular branches of the suprascapular, axillary, subscapular, and lateral pectoral nerves within individual patients., Design: Technical note., Methods: Cadaveric studies delineating the sensory innervation of the shoulder joint were reviewed, and a more comprehensive radiofrequency ablation protocol is proposed relative to historical descriptions., Conclusions: The proposed radiofrequency ablation protocol, which is based on neuroanatomic dissections of the shoulder joint, will provide a safe means of more complete sensory denervation and potentially improve clinical outcomes compared with historical descriptions, the efficacy of the new protocol must be confirmed in prospective studies., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Academy of Pain Medicine.)

Introduction: Alterations of scapular kinematics are generically reported as scapular dyskinesis (SD), and are a nonspecific response to various shoulder pathologies. The most widely used classification is Kibler's (K), which is, however, characterized by poor sensitivity. To overcome this limit, using a 3D motion analysis system, we identified a specific pattern for each type of SD according to Kibler., Materials and Methods: We analyzed 34 patients with a total of 68 shoulders who came to our observation for shoulder pain. All patients underwent clinical examination, video-recording and motion analysis with SHoW Motion 3D kinematic tracking system (SM). Three independent observers classified SD into K types I, II and III. Only patients with concordant classification among the 3 operators were studied to identify a characteristic graphic pattern by type of SD., Results: Typical patterns emerged from the examination with SM. K. type 1 consists of decreased or reversed posterior tilt and increased protraction in flexion-extension (FE) in early degrees of motion. K. type 2 consists of increased protraction and marked reversal of lateral rotation in abduction-adduction (Ab-Ad) in early degrees of movement. K. type 3 has been subdivided into two subgroups: K. type 3-A, composed of patients with massive rotator cuff lesions, shows an increase in all scapular movements in both FE and Ab-Ad. K. type 3-B, composed of patients with scapular stiffness and/or impingement, presents a slight increase in posterior tilt and lateral rotation in the final grades of FE and Ab-Ad., Conclusions: The SM system allows reproducible dynamic analyses with low intra- and intra- operator variability. In our study, we demonstrated its applicability in the classification of SD. It also provides an objective and quantitative assessment of motor pattern alteration that is essential in the follow-up of patients to evaluate the effectiveness of rehabilitation and/or surgical treatment. LEVEL OF EVIDENCE 3: According to "The Oxford 2011 Levels of Evidence"., (© 2024. The Author(s).)

Background: There are several therapeutic options for the management of shoulder adhesive capsulitis (AC). The superiority of arthro-distension over intra-articular steroid injection (ISI) for AC remains controversial., Objectives: To evaluate the efficacy of a single arthro-distension procedure combined with early and intensive mobilization (ADM) and physiotherapy, versus ISI and physiotherapy, in people with AC lasting ≥3 months., Methods: This was a prospective, 2 parallel-group, 2-center, observer-blind randomized controlled trial conducted in tertiary care settings. Adults with AC were randomly assigned to the treatment or control group. Efficacy was assessed using the self-administered Shoulder Pain and Disability Index (SPADI). Total, pain and disability SPADI scores 15 days, 6 weeks, and 3, 6 and 12 months after the procedure (total SPADI at 15 days: primary outcome; other outcomes were secondary) were compared between groups using analysis of covariance (ANCOVA). A post hoc analysis stratified on the initial range of passive glenohumeral abduction, which had not been pre-specified, was conducted., Results: There were 33 participants in each group. Both groups improved over time. Mean (SD) total SPADI score at 15 days was 33.8 (19.6) in the treatment group and 32.8 (17.5) in the control group, p = 0.393. There were no significant differences for any variables in the overall sample. The post hoc analysis found ADM to be associated with a significant decrease in total SPADI score at 15 days compared with ISI (p = 0.049) in individuals with initial passive glenohumeral abduction >45°., Conclusions: The effects of ADM on pain and function were not statistically different from those of ISI. However, ADM may be useful in individuals with initial passive glenohumeral abduction >45°., Database Registration: NCT00724113., Competing Interests: Declaration of competing interest Prof. Christelle Nguyen has the following conflicts of interest: grants or contracts from the French Ministry of Health; consulting fees from Thuasne and Merz; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Thuasne, Novartis, Pfizer, and Lilly; support for attending meetings and/or travel from Grünenthal; and participation on a Data Safety Monitoring Board or Advisory Board from Thuasne. The other authors do not have any conflict of interest., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Competing Interests: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Background: The mechanistic response of rotator cuff tendons to exercises within the context of rotator cuff-related shoulder pain (RCRSP) remains a significant gap in current research. A greater understanding of this response can shed light on why individuals exhibit varying responses to exercise interventions. It can also provide information on the influence of certain types of exercise on tendons. The primary aim of this article is to explore if changes in supraspinatus tendon thickness (SSTT) ratio differ between exercise interventions (high load vs. low load). The secondary aims are to explore if changes in SSTT ratio differ between ultrasonographic tendinopathy subgroups (reactive vs. degenerative) and if there are associations between tendinopathy subgroups, changes in tendon thickness ratio, and clinical outcomes (disability)., Methods: This study comprises secondary analyses of the combined dataset from two randomized controlled trials that compared high and low-load exercises in patients with RCRSP. In those trials, different exercise interventions were compared: 1) progressive high-load strengthening exercises and 2) low-load strengthening with or without motor control exercises. In 1 trial, there was also a third group that was not allocated to exercises (education only). Ultrasound-assessed SSTT ratio, derived from comparing symptomatic and asymptomatic sides, served as the primary measure in categorizing participants into tendinopathy subgroups (reactive, normal and degenerative) at baseline., Results: Data from 159 participants were analyzed. Two-way repeated measures ANOVAs revealed significant Group (P < .001) and Group × Time interaction (P < .001) effects for the SSTT ratio in different tendinopathy subgroups, but no Time effect (P = .63). Following the interventions, SSTT ratio increased in the "Degenerative" subgroup (0.14 [95% confidence interval {CI}: 0.09-0.19]), decreased in the "Reactive" subgroup (-0.11 [95% CI: -0.16 to -0.06]), and remained unchanged in the "Normal" subgroup (-0.01 [95% CI: -0.04 to 0.02]). There was no Time (P = .21), Group (P = .61), or Group × Time interaction (P = .66) effect for the SSTT ratio based on intervention allocation. Results of the linear regression did not highlight any significant association between the tendinopathy subgroup (P = .25) or change in SSTT ratio (P = .40) and change in disability score., Conclusion: Findings from this study suggest that, over time, SSTT in individuals with RCRSP tends to normalize, compared to the contralateral side, regardless of the exercise intervention. Different subgroups of symptomatic tendons behave differently, emphasizing the need to potentially consider tendinopathy subtypes in RCRSP research. Future adequately powered studies should investigate how those different tendinopathy subgroups may predict long-term clinical outcomes., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Aims: This study aimed to describe clinical characteristics and sleep quality of Parkinson's Diseases (PD) patients and identify associated factors with sleep quality., Methods: A cross-sectional study was conducted at the National Geriatric Hospital, Hanoi, Vietnam, from December 2022 to April 2023. A total of 130 Parkinson's disease patients undergoing treatment at the hospital were invited. Demographic and clinical characteristics were obtained. The diagnosis of sleep disorders was based on the standards outlined in the DSM-V. A multivariate logistic regression model was employed., Results: 90.9 % experienced sleep disorder, with the significant types including insomnia (76.2 %) and restless legs syndrome (56.2 %). The majority of patients suffered two (33.1 %) and one kind of sleep disorder (32.3 %). Most patients experienced sleep disorders after diagnosis of PD (80.0 %). Only having shoulder and neck pain was positively associated with a likelihood of having sleep disturbances (OR=4.87, 95 %CI=1.18-20.15)., Conclusion: This study found a high rate of sleep disorders among PD patients in our sample. Shoulder and neck pain was found to be associated with a risk of sleep disorders. Pain management should be performed to improve the sleep quality of PD patients., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Competing Interests: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Winged scapula is a rare musculoskeletal condition with numerous etiologies including spinal accessory nerve (SAN) palsy. Sport activities are rarely implicated with few scattered case reports. We report a case of an 18-year-old bodybuilder who suffered SAN palsy secondary to weightlifting exercises. Physical examination revealed winged scapula with painful mobility of the shoulder. A scapular magnetic resonance imaging scan and electromyography of the trapezius muscle were performed and confirmed the diagnosis of SAN palsy. Through this case, we review the literature of common and rare causes of SAN palsy and outline accepted treatment options., Competing Interests: The authors report no potential conflicts of interest in the development or publication of this article.

Introduction: Adhesive capsulitis (AC), often referred to as frozen shoulder, presents a diagnostic challenge due to its insidious onset and progressive nature. The condition is characterized by pain and restricted motion in the shoulder, with a predilection for individuals between 40 and 60 years of age. A novel scoring system was developed to enhance the accuracy of diagnosing AC and distinguishing between its stages, aiming to streamline clinical decision-making and treatment planning., Methods: A cohort of patients with symptoms suggestive of AC was assessed using the new scoring system, which integrates clinical, radiological, and patient history factors. Parameters included comorbidities like diabetes mellitus, recent immobility, rotator cuff tears, and specific ultrasound findings. Patients were scored and categorized into definitive AC, uncertain diagnosis, or exclusion from AC, with scores > 7, 6-2, and < 2, respectively., Results: The scoring system effectively categorized patients, with those scoring > 7 demonstrating pronounced symptoms and ultrasound changes consistent with Phase 2 AC. Patients with scores between 6 and 2 were classified into uncertain Phase 1 or Phase 3, necessitating further observation. Scores < 2 effectively excluded AC, indicating a need to explore alternative diagnoses., Conclusion: The structured scoring system demonstrated potential as a comprehensive tool for diagnosing AC. By quantitatively assessing a range of contributory factors, it allowed for the stratification of the disease into distinct stages. This system is anticipated to improve early diagnosis and the precision of treatment interventions, although further validation in larger cohorts is warranted., Level of Evidence: II-III., (© 2024. The Author(s).)

Purpose: Lung-recruitment maneuvers (LRM) have been shown to reduce postoperative pain after laparoscopic surgery. This study aimed to investigate the association of LRM with the incidence of shoulder pain after laparoscopic cholecystectomy., Methods: A randomized controlled study was conducted with 110 patients undergoing elective laparoscopic cholecystectomy from July 2022 to March 2023. Participants were randomized to receive either routine exsufflation or LRM at pneumoperitoneum release. The postoperative shoulder pain and abdominal pain were assessed at 1, 4, 6, 12, and 24 h after surgery using a numeric rating scale. Analgesic consumption and postoperative nausea or vomiting (PONV) were evaluated during the first 24 h after surgery., Results: The incidence of shoulder pain during the first 24 h after surgery was significantly lower in the LRM group compared to the control group (26.9 vs. 59.3%; P = 0.001). The median [interquartile range] score of worst shoulder pain was significantly lower compared to the control group (3 [2-3] vs 4 [3-5.5]; P = 0.003). Participants in the LRM group showed reduced abdominal pain at rest at 4 and 24 h after surgery, and experienced significantly lower intensities of abdominal pain during mobilization at all time points over 24 h after surgery. There were no significant differences in opioid consumption or the incidence of PONV between the groups., Conclusions: LRM reduces both the incidence and intensity of shoulder pain during 24 h after laparoscopic cholecystectomy. Additionally, LRM was associated with reduced intensity of abdominal pain during mobilization over the study period., Competing Interests: Declarations. Conflict of interest: The authors declare that they have no conflict of interest., (© 2024. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.)

Background: Studies evaluating the results of platelet-rich plasma (PRP) for the treatment of rotator cuff tendinopathy have demonstrated conflicting results and have been confounded by small patient samples, the absence of a control group, the combined analysis of isolated tendinopathies and rotator cuff tears, and insufficient reporting of PRP preparations. The purpose of this study was to perform a randomized controlled trial (RCT) comparing PRP with standard corticosteroid injections in providing pain relief and improved function in patients with rotator cuff tendinopathy., Methods: This was a double-blind RCT at a single center. We evaluated patients between 18 and 50 years old who had both a clinical and magnetic resonance imaging diagnosis of supraspinatus tendinopathy refractory to conservative treatment. A total of 50 patients received PRP treatment, whereas 50 patients received a corticosteroid, as a control group. Patients completed patient-reported outcome assessments at baseline and at 1, 3, 6 and 12 months after injection. The primary outcome was improvement in the visual analog scale (VAS) score for pain. Secondary outcomes included changes in American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Single Assessment Numeric Evaluation (SANE) score, and the Pittsburgh Sleep Quality Index (PSQI). Treatment failure was defined as persistent pain at 3 months that required a subsequent injection., Results: The mean age was 27.7 years (±7.4). All the patients completed 12 months of clinical follow-up. At 12 months, patients in the PRP group showed a significantly greater improvement in the VAS score than patients in the corticosteroid group: 1.68 (0.6) vs. 2.3 (1.0) (P < .001). As well, at the 12-month follow-up, the 3 scores evaluated were significantly higher in patients treated with PRP than in patients treated with corticosteroid: ASES, 89.8 (6.3) vs. 78.0 (8.6) (P < .001); SANE, 89.2 (6.3) vs. 80.5 (9.6) (P < .001); and PSQI, 2.72 (0.6) vs. 4.02 (1.7) (P < .001). The overall failure rate was significantly higher in the corticosteroid group (30%) than in the PRP group (12%) (P < .01)., Conclusion: One subacromial PRP injection in patients with rotator cuff tendinopathy showed significantly superior and sustained pain-relieving and functional improvements compared with one corticosteroid subacromial injection assessed by 4 patient-reported outcome scales at the 12-month follow-up. Moreover, the overall failure rate was significantly higher in the corticosteroid group than in the PRP group., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Ewing sarcoma is a malignant round-cell tumor that primarily affects bones in children. It can also arise in extraosseous tissues, such as the lung, kidneys, and liver. The presentation symptoms of Ewing sarcoma may include cough, dyspnea, and chest pain., Case Presentation: This report details the history of a 15-year-old Syrian boy with a previous diagnosis of Hodgkin lymphoma who presented with chronic shoulder pain. Imaging studies revealed an 80 mm mass in the apex of the left lung, which was confirmed through histopathological examination to be Ewing sarcoma following a computed-tomography-guided biopsy. The patient received multiple cycles of chemotherapy and subsequently underwent surgical resection of the remaining mass., Conclusions: This case highlights the rare occurrence of Ewing sarcoma in the lung and the unusual clinical presentation of shoulder pain without other accompanying symptoms., (© 2024. The Author(s).)

BACKGROUND Pigmented villonodular synovitis is a rare clinical entity, with 2-3% of all PVNS cases affecting the shoulder. Diagnosis is challenging and can elude clinicians for years, with definitive treatment involving arthroscopic or open synovectomy. CASE REPORT A 50-year-old woman presented with left shoulder pain persisting for 2 years. She was initially conservatively treated by a rheumatologist, with corticosteroid schemes intra-articularly injected and per os, but no improvement of her symptoms was noted. Two years later, she was referred to the Orthopedics Department of our hospital with constant pain in her left shoulder, refractory to the conservative measures. Physical examination revealed tenderness of her shoulder on palpation and limited range of motion. The diagnosis of PVNS was established by preoperative magnetic resonance arthrography (MRA) and confirmed by biopsy from intra-operative tissue sampling. Arthroscopic debridement and synovectomy were performed, yielding good surgical results, and she now reports pain relief, improved function, and no recurrence of symptoms at 1-year follow-up. CONCLUSIONS The diagnosis of PVNS can be elusive for years. MRI and clinical suspicion along with tissue biopsy can set the diagnosis. Shoulder PVNS follows a similar natural history as knee PVNS, with conservative treatment failing and arthroscopic excision providing definite relief. We report a rare case of shoulder PVNS, underscoring the importance of considering PVNS in cases of shoulder pain refractory to conservative treatment.

Background: To develop a nursing program for the prevention and rehabilitation of shoulder and neck discomfort after thyroid cancer surgery based on the empowerment theory, and to evaluate the application effect of the program., Methods: The prevention and rehabilitation nursing program for shoulder and neck discomfort after thyroid cancer surgery was established by literature review and the Delphi method. Between July 2022 and January 2023, a total of 62 postoperative thyroid cancer patients were recruited and randomly allocated to either the intervention group (n = 31) or the control group (n = 31) in this randomized controlled trial. Comparisons of shoulder and neck function, self-efficacy, and quality of life between the 2 groups were performed using a 2-sample independent t test, Wilcoxon rank-sum test, and repeated-measures analysis of variance., Results: At the end of the study, the control group and intervention group were 30 cases each completed the study. After the intervention, the self-efficacy score of the intervention group was higher than the control group (P < .05), and the score of emotional function, cognitive function, and overall health dimension of the intervention group was higher than the control group (P < .05). The pain dimension score of the intervention group was lower than the control group (P < .05). There were significant differences in the group and time effects of the total shoulder joint scores between the 2 groups (P < .05)., Conclusion: This study demonstrated that the shoulder and neck rehabilitation nursing program can alleviate the symptoms of shoulder and neck discomfort and improve patients' self-efficacy and quality of life., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: The effectiveness of telemedicine in aiding rehabilitation exercises among patients with rotator cuff (RC) disorders remains unknown. Therefore, this meta-analysis aimed to assess the effectiveness of telemedicine in patients with RC disorders., Methods: Randomized clinical trials (RCTs) on the effectiveness of telemedicine in patients with RC disorders were summarized through a meta-analysis. A systematic search for these RCTs was conducted in PubMed, Cochrane, Embase, and Web of Science databases up to July 2024. Statistical analysis was performed using Stata 16. Publication bias was estimated with the funnel plot and Egger's test., Results: Ten studies involving 497 participants (telemedicine group = 248 and conventional group = 249) were enrolled, with follow-up durations ranging from 8 weeks to 48 weeks. Functional outcomes measured by the Constant-Murley score were markedly improved after treatment in the telemedicine group compared to the conventional group. Moreover, compared to conventional treatment, telemedicine significantly improved shoulder function evaluated by Quick Disabilities of the Arm, Shoulder, and Hand Score, relieved pain assessed by visual analog scale pain score, and improved range of motion after treatment and in the final follow-up period., Conclusion: Telemedicine has demonstrated potential in alleviating pain and enhancing shoulder function and motion in patients with RC injuries. It may be a feasible intervention for rehabilitation exercises. Further research with a large sample size and standardized treatment is warranted to validate these findings., (© 2024. The Author(s).)

Objectives: Shoulder pain is common but current clinical classification has limited utility. We aimed to determine whether groups of ultrasound-based shoulder pathologies exist and to evaluate outcomes according to identified groups and individual pathologies., Methods: This was a prospective study of a community-based cohort with shoulder pain referred for their first ultrasound scan at a single radiology unit, with subsequent routine clinical care. Patient-reported outcomes were collected at baseline, 2 weeks and 6 months; standardized ultrasound reporting was employed. Latent class analysis (LCA) identified ultrasound pathology-based groups. Multiple linear regression analysis explored associations between baseline pathologies, subsequent treatment and Shoulder Pain and Disability Index (SPADI). Short-term response to corticosteroid injections was investigated., Results: Of 500 participants (mean age 53.6 years; 52% female), 330 completed follow-up. LCA identified four groups: bursitis with (33%) or without (27%) acromioclavicular joint degeneration, rotator cuff tear (21%) and no bursitis/tear (19%). Total SPADI was higher at baseline for cuff tears (mean 55.1 vs 49.7-51.3; overall P = 0.005), but accounting for this, groups did not differ at 6 months (43.5 vs 38.5-40.5; P = 0.379). Baseline SPADI was the only predictor of 6-month SPADI retained by penalized modelling; neither LCA-derived ultrasound groups nor individual pathologies were selected. Response to baseline injection at week 2 did not differ between groups (mean SPADI 40.1-43.8; P = 0.423)., Conclusion: Ultrasound-based classification (groups or individual pathologies) of shoulder pain did not predict medium-term outcomes using current treatments. The role of routine diagnostic ultrasound for shoulder pain needs consideration; it may be useful to establish evidence-based therapies for specific pathologies., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Background: Shoulder orthoses reduce the gravitational pull on the shoulder by providing an upward force to the arm, which can decrease shoulder pain caused by stress on the glenohumeral structures., Objective: In this interventional study, the clinical effects of a recently developed dynamic shoulder orthosis were assessed in 10 patients with chronic shoulder pain. The shoulder orthosis provides an upward force to the arm with 2 elastic bands. These bands are arranged to statically balance the arm, such that the supportive force is always directed toward the glenohumeral joint and shoulder movements are not impeded., Study Design: Clinical effect study., Methods: The study population was provided with a dynamic shoulder orthosis for 2 weeks. In the week before the orthosis fitting, the participants had no intervention. The primary outcome measures were the mean shoulder pain scores before and during the intervention, and the distance between the humeral head and the acromion without and with orthosis., Results: Ultrasound evaluation showed that the shoulder orthosis resulted in a reduction of the distance between the acromion and humeral head at different levels of arm support. In addition, it was demonstrated that the mean shoulder pain scores (range 0-10) decreased from 3.6 to 3 (in rest) and from 5.3 to 4.2 (during activities) after 2 weeks of orthosis use. In general, patients were satisfied with the weight, safety, ease in adjusting, and effectiveness of the orthosis., Conclusions: The results of this study show that the orthosis has the potential to reduce shoulder complaints in patients with chronic shoulder pain., (Copyright © 2023 International Society for Prosthetics and Orthotics.)

Purpose: The aim of this study was to determine the effect of breathing and coughing exercises and oxygen therapy on shoulder pain and analgesic consumption after laparoscopic cholecystectomy., Design: A randomized controlled intervention study., Methods: The sample included 105 patients who underwent elective laparoscopic cholecystectomy at the general surgery clinic of a tertiary center. Breathing and coughing exercises were applied to groups 1 and 2 of the intervention group, from the fourth hour after surgery. In addition, 2 liters per minute O 2 treatment was applied to group 2 during the first hour after surgery, while the control group did not recieve the interventions., Findings: After surgery, a statistically significant difference was found in favor of the intervention groups in pain levels at the 12th hour (P < .05). There was a negative and statistically significant difference between pain levels and SpO 2 values in all groups (P < .05). Non-opioids were consumed in lower amounts in the intervention groups (P > .05), while opioids were consumed only in the control group., Conclusions: Breathing and coughing exercises and oxygen therapy after laparoscopic cholecystectomy reduced shoulder pain and the amount of analgesic consumption., Competing Interests: Declaration of Competing Interest None to report., (Copyright © 2024 The American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Purpose: Postoperative shoulder pain is a common problem after laparoscopic surgery. This study aimed to investigate the association between operative side and postoperative shoulder pain following urologic laparoscopic surgery performed in the lateral recumbent position., Methods: This was a retrospective cohort study conducted at a single tertiary care center. A total of 506 patients who underwent urologic laparoscopic surgery (including adrenalectomy, radical nephrectomy, partial nephrectomy, and pyeloplasty) between January 2010 and December 2019 were included. Patients who underwent total nephroureterectomy or resection of other organs were excluded. The primary outcome was the incidence of postoperative shoulder pain. A multivariable logistic regression analysis investigated the association between the operative side and postoperative shoulder pain., Results: Among the 506 included patients, there were an equal number of surgeries on the left and right sides. Eighty-eight patients had postoperative shoulder pain. The incidence of postoperative shoulder pain in the left-side group was significantly higher than that in the right-side group (21.3% [54/253] versus 13.4% [34/253], crude odds ratio = 1.75, 95% confidence interval [CI] 1.07-2.89). After adjustment for potential confounders (age, sex, body mass index, operation duration, operative technique, epidural block, peripheral nerve block, American Society of Anesthesiologists physical status classification, and intraoperative rocuronium dose), the left operative side was found to be associated with postoperative shoulder pain (adjusted odds ratio = 1.89, 95% CI 1.15-3.09)., Conclusion: The left operative side is associated with an increased incidence of postoperative shoulder pain after urologic laparoscopic surgery performed in the lateral recumbent position., (© 2024. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.)

BACKGROUND Frozen shoulder with limited range of motion is a common and debilitating condition that occurs on the affected side following a stroke. The effectiveness of therapy was reported to be negatively correlated with the complexity of pathogenesis. Prolotherapy involves injection into the joint of a small amount of irritant, such as dextrose, which enhances tissue strength and facilitates healing by targeting joint spaces. The treatment is used to relieve pain. This report describes the effects of combined prolotherapy and physical therapy in a 60-year-old man with left shoulder pain and limited range of motion (frozen shoulder) following a hemiplegic stroke. CASE REPORT A 60-year-old man had left shoulder pain and limited ROM for 9 months, which disrupted daily life, with a NRS of 7 and a DASH score of 58.3%. The patient had an ischemic stroke 1 year ago, with left extremity weakness. On physical examination, joint active ROM was significantly restricted and the joint was tender upon palpation. Therapy is carried out using prolotherapy combined with exercise and physical therapy for 6 weeks. At the 6-week follow-up, he had good outcomes for pain relief, increasing ROM, and quality of life. CONCLUSIONS The use of prolotherapy with physical therapy may be an effective treatment for painful frozen shoulder following a hemiplegic stroke.

The long head of the biceps (LHB) tendon is a common source of shoulder pain. Often associated with other injuries, the tendon can alone be responsible of the symptoms. Spontaneous rupture has been observed to allow for pain relief. The spectrum of LHB lesions is broad. Repetitive motion, carrying heavy loads, have been associated with diagnosis. Specific tests have been described to diagnose biceps injuries, their implementation can remain difficult in the presence of associated pathologies. The combination of a history and clinical examination with the use of targeted imaging is required to establish the diagnosis. The management of bicipital pathologies is frequently carried out following main surgical procedures. Isolated management of biceps lesions can provide a satisfactory result when a comprehensive procedure cannot be performed., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Referred chronic shoulder pain may arise from diaphragmatic irritation. It can potentially be alleviated by blockade of the phrenic nerve. There is literature describing its use in acute pain conditions; yet for chronic pain, there are no reports. We present 2 cases of chronic diaphragmatic irritation causing ipsilateral referred shoulder pain. Patients experienced significant pain relief and a reduction in opioid consumption after receiving an ultrasound-guided phrenic nerve block. While the phrenic nerve block shows promise for pain relief, carefully evaluating its benefits and risks is recommended before considering its application in selected cases., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 International Anesthesia Research Society.)

Objective: To compare the mid-term effectiveness of arthroscopic shoulder capsular release combined with acromiohumeral distance (AHD) restoration in the treatment of diabetic secondary stiff shoulder and primary frozen shoulder., Methods: A retrospective analysis was conducted on clinical data of 22 patients with diabetic secondary stiff shoulder (group A) and 33 patients with primary frozen shoulder (group B), who underwent arthroscopic 270° capsular release combined with AHD restoration treatment. There was no significant difference between the two groups in gender, age, affected side, disease duration, and preoperative AHD, shoulder flexion range of motion, abduction range of motion, American Shoulder and Elbow Surgeons (ASES) score, visual analogue scale (VAS) score, and Constant score ( P >0.05). Only the difference in the internal rotation cone rank and external rotation range of motion between the two groups showed significant differences ( P <0.05). The improvement in shoulder pain and function was evaluated by using VAS score, ASES score, and Constant score before operation and at last follow-up. Active flexion, abduction, external rotation range of motion, and internal rotation cone rank were recorded and compared. AHD was measured on X-ray films., Results: All patients were followed up 24-92 months (median, 57 months). There was no significant difference in follow-up time between group A and group B ( P >0.05). No fractures or glenoid labrum tears occurred during operation, all incisions healed by first intention, and no complication such as wound infection or nerve injury was observed during the follow-up. At last follow-up, there were significant improvements in active flexion, abduction, external rotation range of motion, internal rotation cone rank, AHD, VAS score, ASES score, and Constant score when compared with preoperative ones in both groups ( P <0.05). Except for the difference in change in external rotation range of motion, which had significant difference between the two groups ( P <0.05), there was no significant difference in other indicators between the two groups ( P >0.05)., Conclusion: Arthroscopic capsular release combined with AHD restoration can achieve good mid-term effectiveness in the treatment of diabetic secondary stiff shoulder and primary frozen shoulder. However, the improvement in external rotation range of motion is more significant in the patients with diabetic secondary stiff shoulder.

First rib fractures are uncommon, mainly in paediatric population, considering its anatomic features and their skeleton plasticity. Traditional teaching usually characterizes it as a hallmark of severe trauma. Herein, to unfold awareness to an unnoticed diagnosis, we describe two paediatric cases of isolated first rib fracture in adolescents without a clear identifiable cause nor an underlining trauma mechanism. Neurovascular injuries should always be investigated, as fracture of the first rib with ensuing callus formation is a rare but fearing cause of thoracic outlet syndrome. We highlight the scarcity of reports on isolated first rib fractures outside of sports medicine, as well as the importance of considering this otherwise easily missed diagnosis in a common complaint in children.

Background: Appropriate preoperative management of patients with chronic moderate to severe shoulder pain who are candidates for surgery owing to rotator cuff disease or glenohumeral osteoarthritis may improve surgery and patient outcomes, but published evidence in this regard is scarce. Therefore, the availability of recommendations on preoperative interventions based on expert consensus may serve as guidance., Methods: A Delphi study was conducted to develop a preoperative management algorithm based on a national expert consensus. A Delphi questionnaire was developed by a scientific committee following a systematic review of the relevant literature published during the past 10 years using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) criteria. It consisted of 48 statements divided into 5 blocks (block I, assessment and diagnosis of preoperative pain; block II, preoperative function and psychosocial aspects; block III, therapeutic objectives; block IV, treatment; and block V, follow-up and referral), and 28 experienced shoulder surgeons from across the country were invited to answer., Results: All participants responded to the Delphi questionnaire in the first round, and 25 responded in the second round (89.3% of those invited). Overall, 46 of 49 final statements reached a consensus, on the basis of which a final preoperative management algorithm was defined by the scientific committee. First, surgeons should assess shoulder pain intensity and characteristics, shoulder functionality, and psychosocial aspects using specific validated questionnaires. Preoperative therapeutic objectives should include shoulder pain control, depression and/or nocturnal sleep improvement, opioid consumption adjustment, and substance abuse cessation. Postoperative objectives regarding the degree of shoulder pain reduction or improvement in functionality and/or quality of life should be established in agreement with the patient. Treatment of preoperative chronic moderate to severe shoulder pain should comprise nonpharmacologic as well as pharmacologic interventions. Follow-up of the shoulder pain levels, treatment adherence, and mental health status of these patients may be carried out by the surgical team (surgeon and anesthesiologist) together with the primary care team. Patients with very intense shoulder pain levels may be referred to a pain unit following specific protocols., Conclusion: A preoperative management algorithm for patients with chronic moderate to severe shoulder pain who are candidates for surgery owing to rotator cuff disease or glenohumeral osteoarthritis was defined based on a national expert consensus. Main points include comprehensive patient management starting with an objective assessment of shoulder pain and function, as well as quality of life; establishment of preoperative and postoperative therapeutic targets; prescription of individualized therapeutic interventions; and multidisciplinary patient follow-up. Implementation of these recommendations into clinical practice may result in better preoperative shoulder pain management and more successful surgical outcomes and patient satisfaction., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: After stroke, the effects of focused scapulo-humeral training with simultaneous assessment of the changes in shoulder subluxation, related muscle thicknesses and upper limb performance have not been studied in the literature., Objectives: This study aimed to investigate the effects of an 8-week scapulo-humeral training program in addition to conventional rehabilitation on upper extremity/trunk functions, shoulder pain, and sonographic measurements of the shoulder joint and periscapular muscles., Methods: Thirty stroke individuals were randomly separated into two groups as Group I-scapulo-humeral training (5F/10 M) and Group II - control (5F/10 M). Conventional rehabilitation program was applied to both groups, and a scapulo-humeral training exercise protocol was added for the scapulo-humeral group. All the treatments were applied for 1 hour/day, 3 days/week, 8 weeks. Clinical evaluations were made using the Fugl Meyer Assessment-Upper Extremity(FMA-UE), Action Research Arm Test(ARAT), ABILHAND, Visual Analog Scale, and Trunk Impairment Scale(TIS). Ultrasound was used to measure serratus anterior/lower trapezius muscle thicknesses, and acromion-greater tubercule/acromio-humeral distances., Results: FMA-UE, ARAT, ABILHAND and TIS scores increased in both groups, with greater increases in most parameters in the scapulo-humeral training group. Shoulder pain decreased only in the scapulo-humeral training group. Subacromial distances were decreased on the paretic side, and muscle thicknesses increased on both sides in the scapulo-humeral training group, and in the control group, only serratus anterior muscle thickness increased on the paretic side ( p  < 0.05 for all)., Conclusions: Additional scapulo-humeral exercises to conventional rehabilitation was seen to improve upper extremity/trunk performance and shoulder pain, and to increase scapula stabilizer muscle thicknesses in stroke individuals with mild-moderate upper extremity disability.

Background: No reports have been published verifying the effects of manual interventions such as humeral head stabilization on improving function and reducing pain when applying aggressive manual passive stretching in patients with painful stiff shoulders. The purpose of this study was to compare clinical outcomes, such as range of motion, pain, and disability scores, in patients with painful stiff shoulders with and without humeral head stabilization intervention while applying aggressive manual passive stretching., Methods: Fifty-six patients with painful stiff shoulders were recruited (31 with humeral head stabilization intervention and 25 without such intervention). Clinical outcomes such as active range of motion (A-ROM), pain, and disability scores were evaluated using a goniometer; measurement of activity visual analog scale (A-VAS); and Disabilities of the Arm, Shoulder and Hand (DASH) and Shoulder Pain and Disability Index (SPADI), respectively., Results: All the parameters, A-ROM, A-VAS, and disability scores (DASH and SPADI) were not significantly different between the 2 groups (P > .05) before the intervention. However, after the intervention, the mean difference in A-ROM for flexion, abduction, and external and internal rotation was 18 (95% confidence interval [CI], 14.1-21.7), 31 (95% CI, 24.9-37.4), 17 (95% CI, 13.4-21.4), and 16 (95% CI, 11.6-20.9), respectively. The mean difference in A-VAS and disability scores for DASH and SPADI was -1 (95% CI, -1.5 to -0.8), -27 (95% CI, 32.3 to -22.6), and -23 (95% CI, -27.8 to -18.3), respectively. All of these measurements favored humeral head stabilization., Conclusion: During aggressive manual passive stretching in patients with painful stiff shoulders, humeral head stabilization intervention may be more beneficial in improving clinical outcomes such as A-ROM, A-VAS pain levels, and disability scores., (Copyright © 2024. Published by Elsevier Inc.)

Background: Although various treatment options are available for spinoglenoid cyst, including conservative and surgical methods, there is no standard guideline for its surgical decompression. Thus, the purpose of the study was to correlate the size of the spinoglenoid notch ganglion cyst (GC) as revealed by magnetic resonance imaging (MRI) with electrophysiological alterations, muscle power, and pain severity, and to estimate a cut-off value of cyst size to perform a decompression., Methods: Between January 2010 and January 2018, the patients with a GC at the spinoglenoid notch diagnosed on MRI, and who had a minimum follow-up of 2 years after the decompression were included. Maximum cyst diameter as measured on MRI was used for comparison. Electromyography (EMG) and nerve conduction velocity (NCV) studies were performed before the surgery. Peak torque deficit (PTD) percentage compared to opposite shoulder was calculated preoperatively and at 1 year after surgery. Pain severity was estimated using visual analogue scale (VAS) preoperatively., Results: Ten (50%) of 20 patients with GC > 2.2 cm and 1 (5.9%) of 17 patients with GC < 2.2 cm showed EMG/NCV abnormalities (p = 0.019). There was a correlation between the cyst size and the positive EMG/NCV findings (Correlation coefficient (CC) = 0.535, p < 0.001). The preoperative peak torque deficit on the external rotation was correlated with the positive EMG/NCV findings (CC = 0.373, p = 0.021). The PTD was improved significantly at 1 year postoperatively in patients with a GC size >2.2 cm (p = 0.029). The cyst size was not related to the preoperative pain VAS and muscle power., Conclusions: The spinoglenoid cyst size >2.2 cm, but not pain severity or muscle power, correlates with the positive finding of EMG for compressive suprascapular neuropathy. The GC size >2.2 cm can be a reference to decide the need of decompression surgery., Level of Evidence: IV, case series., Competing Interests: Conflict of interest All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript., (Copyright © 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)