• Clinics in Shoulder and Elbow
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• v.25 no.3
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• pp.202-209
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• 2022

Background: The purpose of our study was to investigate short-term outcomes of two-stage reverse total shoulder arthroplasty (RTSA) with an antibiotic-loaded cement spacer for shoulder infection. Methods: Eleven patients with shoulder infection were treated by two-stage RTSA following temporary antibiotic-loaded cement spacer. Of the 11 shoulders, nine had pyogenic arthritis combined with complex conditions such as recurrent infection, extensive osteomyelitis, osteoarthritis, or massive rotator cuff tear and two had periprosthetic joint infection (PJI). The mean follow-up period was 29.9 months (range, 12-48 months) after RTSA. Clinical and radiographic outcomes were evaluated using the visual analog scale (VAS) score for pain, American Shoulder and Elbow Surgeons (ASES) score, subjective shoulder value (SSV), and serial plain radiographs. Results: The mean time from antibiotic-loaded cement spacer to RTSA was 9.2 months (range, 1-35 months). All patients had no clinical and radiographic signs of recurrent infection at final follow-up. The mean final VAS score, ASES score, and SSV were significantly improved from 4.5, 38.6, and 29.1% before RTSA to 1.7, 75.1, and 75.9% at final follow-up, respectively. The mean forward flexion, abduction, external rotation, and internal rotation were improved from 50.0°, 50.9°, 17.7°, and sacrum level before RTSA to 127.3°, 110.0°, 51.8°, and L2 level at final follow-up, respectively. Conclusions: Two-stage RTSA with antibiotic-loaded cement spacer yields satisfactory short-term clinical and radiographic outcomes. In patients with pyogenic arthritis combined with complex conditions or PJI, two-stage RTSA with an antibiotic-loaded cement spacer would be a successful approach to eradicate infection and to improve function with pain relief.

• Clinics in Shoulder and Elbow
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• v.25 no.2
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• pp.129-139
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• 2022

Background: Several therapeutic methods have been proposed for frozen shoulder syndrome. These include suprascapular nerve block, a simple and cost-effective technique that eliminates the need for nonsteroidal anti-inflammatory drug therapy. Methods: This was a clinical trial that included patients with unilateral shoulder joint stiffness. Patients were divided into three groups: those treated with isolated physiotherapy for 12 weeks (PT group), those treated with a single dose intra-articular injection of corticosteroid together with physiotherapy (IACI group), and those treated with a suprascapular nerve block performed with a single indirect injection of 8-mL lidocaine HCL 1% and 2 mL (80 mg) methylprednisolone acetate together with physiotherapy (SSNB group). The variables assessed were age, sex, side of involvement, dominant limb, presence of diabetes, physical examination findings including erythema, swelling, and muscle wasting; palpation and movement findings; shoulder pain and disability index (SPADI) score; and the visual analog scale (VAS) score pre-intervention and at 2-, 4-, 6-, and 12-week post-intervention. Results: Ninety-seven patients were included in this survey (34 cases in the PT group, 32 cases in the IACI group, and 31 cases in the SSNB group). Mean age was 48.55±11.06 years. Fifty-seven cases were female (58.8%) and 40 were male (41.2%). Sixty-eight patients had a history of diabetes (70.1%). VAS and SPADI scores and range of mototion degrees dramatically improved in all cases (p<0.001). Results were best in the SSNB group (p<0.001), and the IACI group showed better results than the PT group (p<0.001). Conclusions: Suprascapular nerve block is an effective therapy with long-term pain relief and increased mobility of the shoulder joint in patients with adhesive capsulitis.

• Physical Therapy Rehabilitation Science
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• v.9 no.4
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• pp.269-274
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• 2020

Objective: There are many cases of applying various taping methods to prevent muscle damage and to assist with movement. The purpose of this study was to investigate and to compare the effects of dynamic taping on joint position sense and to find out the difference in error values during various degrees of shoulder flexion. Design: Cross-sectional study. Methods: A total of 20 subjects participated in this study with a randomized cross-over design. The order of taping was adjusted by randomly proceeding with dynamic taping, sham taping, and no taping. After the taping, the proprioception of the shoulder joint was evaluated. The evaluation of proprioceptive sensation was performed by evaluating joint position sensation. The sequence was adjusted by randomly performing joint position tests at each shoulder flexion of 50, 90, and 110 degrees. All angles were repeated 3 times. Results: There was a significant difference between dynamic taping and no taping in 50 degrees of shoulder flexion. There was a significant difference between sham taping and no taping in 90 degrees of shoulder flexion (p<0.05). No significant difference was found in 110 degrees of shoulder flexion. Conclusions: In this study, it was confirmed that dynamic taping is effective in improving the joint position sense in 50 degrees of shoulder flexion. In the future, it is expected that further studies will be conducted on patients with shoulder dysfunction with decreased proprioception.

• Journal of Korean Physical Therapy Science
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• v.29 no.4
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• pp.1-16
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• 2022

Background: This study was conducted to examine the correlation of VDT, posture and shoulder function among each group divided by according to the neck pain disorder index (NDI) scores for female patients with neck pain. Design: Cross-sectional study. Methods: Fifty adult women with neck pain voluntarily participated in this study and the neck pain disorder index questionnaire, VDT syndrome assessment tool questionnaire, craniovertebral angle, thoracic kyphosis angle, round shoulder posture, pectoralis minor length, shoulder joint hypermobility, and serratus anterior strength tests were conducted respectively. Subjects were divided into two groups where 21 subjects were allocated to the mild pain group whom have rated below 14 points on the NDI scores, and 29 subjects were in the severe pain group, whom have rated above 15 on the NDI score. Results: The study found that in the mean difference between variables in each group, VDT syndrome showed a higher mean score in the severe pain group than the mild pain group (p<0.05). In the group correlation and regression analysis, the mild pain group showed a significant negative correlation between the craniovertebral angle and round shoulder posture (r=-0.467, p<0.05), and the round shoulder posture for craniovertebral angle was shown to have significant positive influence (B=10.162, p<0.05). The severe pain group showed that the NDI and the VDT syndrome had a significant amount of correlation (r=0.520, p<0.01), the VDT syndrome showed significant positive influence (B=0.330, p<0.05), and the craniovertebral angle showed significant negative influence (B=-0.809, p<0.05). It was also shown that shoulder joint hypermobility had a significant negative correlation with the serratus anterior strength (r=-0.437, p<0.01), and that serratus anterior strength had a significant negative influence on shoulder joint hypermobility (B=-4.175, p<0.05). Conclusion: This study is of clinical significance in that it presented variables that should be considered depending on the degree of neck pain in treating patients with neck pain and that it presented patients with not only posture but also the function of the shoulder joint as factors to consider.

• Clinics in Shoulder and Elbow
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• v.26 no.1
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• pp.41-48
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• 2023

Background: Shoulder instability procedures have low morbidity; however, complications can arise that result in readmission to an inpatient healthcare facility. The purpose of this study is to identify the demographics and risk factors associated with unplanned 30-day readmission and reoperation following arthroscopic and open treatment for shoulder instability. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried to find patients who underwent shoulder instability surgery from 2015 to 2019. Independent sample Student t-tests, chi-square, and (where appropriate) Fisher's exact tests were used in univariate analyses to identify demographic, lifestyle, and perioperative variables related to 30-day readmission and reoperation following repair for shoulder instability. Multivariate logistic regression modeling was subsequently performed. Results: Of the 11,230 cases included in our sample, only 0.54% were readmitted, and 0.23% underwent reoperation within the 30-day postoperative period. Multivariate logistic regression modeling confirmed that the following patient variables were associated with statistically significantly increased odds of readmission and reoperation: open repair, congestive heart failure (CHF), and hospital length of stay. Conclusions: Unplanned 30-day readmission and reoperation after shoulder instability surgery is infrequent. Patients with American Society of Anesthesiologists class II, CHF, longer than average hospital length of stay, or an open procedure have higher odds of readmission than patients without those factors. Patients who have CHF, longer than average hospital length of stay, and open surgery have higher odds of reoperation than others. Arthroscopic procedures should be used to manage shoulder instability, if possible. Level of evidence: III.

• Clinical Pain
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• v.18 no.2
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• pp.76-81
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• 2019

Objective: To examine (1) the degree of reduction of passive range of motion (PROM) on the affected side compared to that on the unaffected side and (2) the degree of increase in PROM following intra-articular corticosteroid injection (IACI) in patients with frozen shoulder. Method: The medical records of 120 patients with frozen shoulder were retrospectively reviewed. PROM of the unaffected and affected shoulder (flexion, extension, abduction, internal rotation, external rotation) was compared, and changes in PROM of the affected shoulder after a single IACI (triamcinolone 20 mg) were evaluated after 12 weeks. Results: At the time of diagnosis, PROM of the affected shoulder was most limited in external rotation, followed by internal rotation, abduction, extension, and flexion, compared to that of the unaffected shoulder. Compared to before IACI, PROM of external rotation demonstrated the greatest increase compared to all the other movements after IACI. Conclusion: Limitation in PROM of the frozen shoulder at the time of diagnosis was greatest for external rotation. Moreover, external rotation experienced the greatest improvement after IACI. Our findings should help to further clarify the clinical characteristics of frozen shoulder, aid in its diagnosis, and allow the prediction of the effects of IACI.

• Clinics in Shoulder and Elbow
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• v.27 no.1
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• pp.32-38
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• 2024

Background: Open reduction and internal fixation (ORIF) with a locking plate is a popular surgical treatment for proximal humeral fractures (PHF). This study aimed to assess the occurrence of complications in elderly patients with PHF treated surgically using ORIF with a locking plate and to investigate the potential differences between patients treated by shoulder surgeons and non-shoulder surgeons. Methods: A retrospective study was conducted using a single-center database to identify patients aged ≥70 years who underwent ORIF for PHF between January 1, 2011, and December 31, 2021. Data on the Neer classification, follow-up, occurrence of avascular necrosis of the humeral head, implant failure, and revision surgery were also collected. Statistical analyses were performed to calculate the overall frequency of complications according to the Neer classification. Results: The rates of implant failure, avascular osteonecrosis, and revision surgery were 15.7%, 4.8%, and 15.7%, respectively. Complications were more common in patients with Neer three- and four-part fractures. Although the difference between surgeries performed by shoulder surgeons and non-shoulder surgeons did not reach statistical significance, the rate of complications and the need for revision surgery were nearly two-fold higher in the latter group. Conclusions: PHF are highly prevalent in the elderly population. However, the ORIF surgical approach, as demonstrated in this study, is associated with a considerable rate of complications. Surgeries performed by non-shoulder surgeons had a higher rate of complications and a more frequent need for revision surgery. Future studies comparing surgical treatments and their respective complication rates are crucial to determine the optimal therapeutic options. Level of evidence: III.

• Clinics in Shoulder and Elbow
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• v.26 no.3
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• pp.252-259
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• 2023

Background: The purpose of this study was to identify demographics and risk factors associated with unplanned 30-day readmission and reoperation following open procedures for shoulder instability and examine recent trends in open shoulder instability procedures. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried using current procedural terminology (CPT) codes 23455, 23460, and 23462 to find patients who underwent shoulder instability surgery from 2015 to 2019. Independent sample Student t-tests and chi-square tests were used in univariate analyses to identify demographic, lifestyle, and perioperative variables related to 30-day readmission following repair for shoulder instability. Multivariate logistic regression modeling was subsequently performed. Results: In total, 1,942 cases of open surgical procedures for shoulder instability were identified. Within our study sample, 1.27% of patients were readmitted within 30 days of surgery, and 0.85% required reoperation. Multivariate logistic regression modeling confirmed that the following patient variables were associated with a statistically significant increase in the odds of readmission: open anterior bone block/Latarjet-Bristow procedure, being a current smoker, and a long hospital stay (all P<0.05). Multivariate logistic regression modeling confirmed statistically significant increased odds of reoperation with an open anterior bone block or Latarjet-Bristow procedure (P<0.05). Conclusions: Unplanned 30-day readmission and reoperation after open shoulder instability surgery is infrequent. Patients who are current smokers, have an open anterior bone block or Latarjet-Bristow procedure, or a longer than average hospital stay have higher odds of readmission than others. Patients who undergo an open anterior bone block or Latarjet-Bristow procedure have higher odds of reoperation than those who undergo an open soft-tissue procedure. Level of evidence: III.

• Journal of Korean Physical Therapy Science
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• v.31 no.2
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• pp.63-74
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• 2024

Background: This study aimed to determine the effects of static stretching on the pain and range of motion (ROM) of shoulder joints in middle aged women patients with frozen shoulders. Design: One group pretest-posttest design Methods: The participants were 15 middle aged women patients with frozen shoulders in their 40s to 60s. Subjective and objective pain and joint ROM(range of motion) were measured, and the static stretching intervention consisted of 15 minutes of flexion, abduction and external rotation stretching. Results: The results of this study indicated that the daily pain of shoulder joints and pressure pain thresholds of the muscles surrounding the shoulder joints were generally improved after the intervention with the static stretching, for which significant differences were observed (p<0.05). The ROM of shoulder joint flexion, abduction, and external rotation was significantly increased (p<0.05) after the intervention with the static stretching. Conclusion: Static stretching intervention in patients with frozen shoulders relieved shoulder joint pain and had positive effects on the ROM of shoulder joints. Thus, the application of static stretching in middle aged womenpatients who experience severe pain could be effective at enhancing the function of shoulder joints without pain.

• Clinics in Shoulder and Elbow
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• v.18 no.3
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• pp.133-137
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• 2015

Background: The aim of this study was to investigate the demographic and clinical characteristics of patients with primary frozen shoulder in a Korean population. Methods: A total of 1,373 patients whose shoulders were diagnosed with primary frozen shoulder across 11 resident-training hospitals were reviewed retrospectively. Various demographic characteristics and clinical characteristics according to gender and presence of diabetes were evaluated. Results: The average age of patients was 55.4 years. Gender proportion was 58.3% females and 41.7% males. The frozen shoulder involved the non-dominant arm in 60.7% of patients and the bilateral arms in 17.6% of patients. The average duration of symptoms was 8.9 months, and 51.3% of patients had experienced nocturnal pain. Comorbidities associated with frozen shoulder in our sample of patients included diabetes (18.7%), cardiovascular diseases (17.7%), thyroid diseases (5.4%), and cerebrovascular diseases (3.6%). The diabetic group was correlated with the following demographic and clinical characteristics: old age, involvement of the dominant arm, nocturnal pain, long duration of symptoms, and no history of trauma. Further, we found that, in males, having a frozen shoulder was significantly correlated with a history of trauma; in females, having a frozen shoulder was significantly correlated with having thyroid diseases. Conclusions: These demographic data of primary frozen shoulder in the Korean population were consistent with those of previously reported epidemiologic studies. Primary frozen shoulder with diabetes was correlated with old age, bilateral involvement, long duration of symptoms, and nocturnal pain.