Margin convergence has been shown to restore muscle tension in a cadaveric model of a rotator cuff tear. However, the clinical utility of this technique remains uncertain for patients with ...pseudoparalysis caused by an irreparable rotator cuff tear.
(1) For patients with massive irreparable rotator cuff tears, in what proportion of patients does margin convergence reverse pseudoparalysis? (2) In patients with massive irreparable rotator cuff tears, does margin convergence improve American Shoulder and Elbow Surgeons (ASES) scores? (3) What is the survivorship free from MRI evidence of retear after margin convergence?
Between 2000 and 2015, we treated 203 patients for pseudoparalysis with a rotator cuff tear. Pseudoparalysis was defined as active elevation less than 90° with no stiffness, which a physical therapist evaluated in the sitting position using a goniometer after subacromial injection of 10 cc lidocaine to eliminate pain. Of those, we considered patients who underwent at least 3 weeks of unsuccessful nonoperative treatment in our hospital as potentially eligible. Twenty-one percent (43 of 203) who either improved or were lost to follow-up within 3 weeks of nonoperative treatment were excluded. A further 12% (25 of 203) were excluded because of cervical palsy, axillary nerve palsy after dislocation or subluxation, and development of severe shoulder stiffness (passive shoulder elevation < 90°). Repair was the first-line treatment, but if tears were considered irreparable with the torn tendon unable to reach the original footprint after mobilizing the cuff during surgery, margin convergence was used. When margin convergence failed, the procedure was converted to hemiarthroplasty using a small humeral head to help complete the repair. Therefore, 21% (42 of 203) of patients treated with regular repair (18% 36 of 203) or hemiarthroplasty (3% 6 of 203) were excluded. That left 93 patients eligible for consideration. Of those, 13 patients were lost before the minimum study follow-up of 2 years or had incomplete datasets, and 86% (80 of 93) were analyzed (49 men and 31 women; mean age 68 ± 9 years; mean follow-up 26 ± 4 months). Seventy-six percent (61 of 80) were not evaluated in the last 5 years. We considered reversal of pseudoparalysis as our primary study outcome of interest; we defined this as greater than 90° active forward elevation; physical therapists in care measured this in the sitting position by using goniometers. Clinical outcomes were evaluated based on the ASES score from chart review, active ROM in the shoulder measured by the physical therapists, and the 8-month Kaplan-Meier survivorship free from MRI evidence of retear graded by the first author.
Pseudoparalysis was reversed in 93% (74 of 80) patients, and improvement in ASES scores was observed at the final follow-up (preoperative 22 ± 10 to postoperative 62 ± 21, mean difference 40 95% CI 35 to 45; p < 0.01). The 8-month Kaplan-Meier survivorship free from MRI evidence of retear after surgery was 72% (95% CI 63% to 81%). There were no differences in clinical scores between patients with and without retears (intact ASES 64 ± 24, re-tear ASES 59 ± 10, mean difference 6 95% CI -5 to 16; p = 0.27).
Margin convergence can be a good option for treating patients with pseudoparalysis and irreparable rotator cuff tears despite the relatively high retear rates. The proportion of pseudoparalysis reversal was lower in patients with three-tendon involvement. Further studies will be needed to define the appropriate procedure in this group.
Level IV, therapeutic study.
Background:
During pitching, an overloaded joint reaction force exerted on the shoulder and excessive shoulder horizontal abduction at ball release are considered risk factors causing anterior ...shoulder pain for young baseball pitchers.
Hypothesis/Purpose:
The first aim was to examine the relationship between shoulder horizontal abduction position and force on the shoulder at ball release. The second was to identify the relative rotational position of the shoulder and the range of shoulder motion at ball release that minimize force on the shoulder. It was hypothesized that the amount of force on the shoulder would be exacerbated by excessive shoulder horizontal abduction.
Study Design:
Descriptive laboratory study.
Methods:
Participants were 183 adolescent baseball pitchers (mean ± SD age, 15.5 ± 1.2 years) without shoulder/elbow problems. Each pitcher threw 5 fastballs to a catcher behind a home plate. The kinematics and kinetics of the throwing shoulder during fastball pitching were calculated with 3-dimensional measurements from 36 reflective markers. In data analysis, the correlations were calculated between the relative rotational positions of the shoulder (abduction, horizontal adduction-abduction) and the forces on the shoulder (anterior-posterior, proximal, and superior-inferior) at ball release. Subsequently, the specific rotational position and range of motion of the shoulder at ball release that minimized forces on the shoulder were determined.
Results:
Statistically significant correlations were identified between the magnitude of superior-inferior force on the shoulder and shoulder abduction position (R2 = 0.44, P < .001) as well as between the magnitude of anterior-posterior force on the shoulder and shoulder horizontal adduction-abduction position (R2 = 0.72, P < .001). Minimal anterior-posterior and superior-inferior forces were obtained with a combination of 80.6° of shoulder abduction and 10.7° of shoulder horizontal adduction. Any deviation >5° from this position significantly increased the anterior-posterior and superior-inferior forces on the shoulder.
Conclusion:
Increasing shoulder horizontal abduction position significantly increased the magnitude of anterior force on the shoulder at ball release. The combination of 80.6° of shoulder abduction and 10.7° of horizontal shoulder adduction minimized the shear forces on the shoulder at this point.
Clinical Relevance:
The present data can be useful for screening pitching technique to prevent shoulder pain and injury with motion capture assessment.
From 1999 to 2003, 34 patients with unstable distal clavicular fractures (Neer Type 2) had surgery using the acromioclavicular titanium hook plate. To investigate the reliability of clavicular hook ...plate fixation and the effects of hook plates in the subacromial space, we retrospectively reviewed clinical results for pain, shoulder function, range of motion, and radiographic results. The Japanese Orthopaedic Association scores for shoulder disorders indicated good clinical results (mean, 98.3 points). All patients had radiographic bony union. Complications included plate displacement in one patient, acromion fracture caused by widening of the hook hole in one patient, and a rotator cuff tear caused by hook subacromial impingement in one patient. This plate fixation method is useful for treating unstable distal clavicular fracture. However, careful operative planning and familiarity with the technique are necessary to prevent complications including subacromial impingement, rotator cuff damage, acromion fracture, and hook cut-out. Care must be used when establishing the position of the hook hole, and it is best to remove the plate after bony union.
In this study, we have proposed and demonstrated experimentally a novel monitoring device of single mouse embryo activity after in vitro fertilization (IVF) using a semiconductor-based field effect ...transistor (FET). The FET biosensor realized to detect it noninvasively, quantitatively, and continuously by change of hydrogen ions with positive charges, which were induced by dissolved carbon dioxide due to cellular respiration activity during cleavage. The electrical signal of FET biosensor should become an effective indication to evaluate objectively single embryo activity as its morphology is observed subjectively after IVF. The platform based on the FET biosensor will contribute to promote elective single embryo transfer (eSET) in human assisted reproductive technology (ART).
In recent years, the effects of androgens on metabolic and body weight regulation systems and their underlying mechanisms have been gradually revealed in females. In women and experimental animals of ...reproductive age, androgen excess can adversely affect metabolic functioning, appetite, and body weight regulation. In addition, excess androgens can increase the risk of metabolic disorders, such as obesity, insulin resistance, and diabetes. These unfavorable effects of androgens are induced by alterations in the actions of hypothalamic appetite-regulatory factors, reductions in energy expenditure, insulin resistance in skeletal muscle, and β-cell dysfunction. Interestingly, these unfavorable effects of androgens on metabolic and body-weight regulation systems are neither observed nor evident in ovariectomized animals and post-menopausal women, indicating that the adverse effects of androgens might be dependent on the estrogen milieu. Recent findings may provide novel sex- and age-specific strategies for treating metabolic diseases.
Shoulder rotator cuff tears are common disabilities of the shoulder joint caused by daily activities, sports injuries, and aging. Magnetic resonance imaging is widely used to diagnose rotator cuff ...tears, but radiography is a more rapid and popular imaging technique. In this study, we proposed a detection method using convolutional neural networks (CNN) on X-ray images of the shoulder for simpler diagnosis of rotator cuff tears. 139 subjects, classified into two classes according to the severity of the tear, were compared in terms of detection accuracy between five regions of interest on the shoulder and two combinations of CNN models, with a maximum accuracy of 79.3% accuracy.
Dewar’s procedure for transferring the coracoid process with the short head of biceps and coracobrachialis was reported in 1965 for treatment of both acute and chronic acromioclavicular (AC) joint ...separation, but little contemporary literature exists around the procedure. We report the clinical results of coracoid process transfer with excision of the lateral end of the clavicle for chronic AC joint separation.
Fifty-one patients (39 men and 12 women, mean age 46 ± 16 years) were included in the study. Clinical outcomes were evaluated using the American Shoulder and Elbow Surgeons and the Japanese Orthopaedic Association scores, as well as by measuring active range of motion in the shoulder, before-after (minimum follow-up time of 24 months 27 ± 3 months) surgery. Plain radiographs were used to examine stability of the AC joint and bone union of the graft.
The mean American Shoulder and Elbow Surgeons and Japanese Orthopaedic Association scores increased (from 61 ± 14 to 91 ± 6, and from 54 ± 9 to 89 ± 8, respectively) at the time of final follow-up. There were no differences in active elevation and external rotation between before-after operation. Six patients whose grafts were fractured or displaced showed complete or partial loss of reduction of the AC joint.
By transferring the coracoid process, the AC joint regained stability after chronic joint separation. Although potential complications related to the graft still need to be addressed, Dewar’s procedure and lateral clavicle resection could be a reliable treatment of chronic AC joint separation.
Aim
We conducted a self‐administered survey on the perception of teachers toward human papillomavirus (HPV) vaccine to determine the ways to increase their willingness to encourage its use.
Methods
...Answers were obtained both prior to and after having the teachers read five brief information articles: (i) cervical cancer knowledge, (ii) vaccine knowledge, (iii) result of a survey in Nagoya, (iv) news report of the World Health Organization statement and (v) articles written by Dr Muranaka, a journalist.
Results
Most of the respondents (180/247) did not know about the natural history of cervical cancer. Only 36% knew that HPV is the cause of cervical cancer, although 63% knew that HPV vaccine would prevent cervical cancer. Few respondents had knowledge regarding adverse events following immunization and the survey results from Nagoya.
Among those who were initially negative for the HPV vaccine, only 43% revealed that they fully understood its safety and only 29% reversed their opinion to recommend vaccination to their daughters and/or students, even after reading our informational material. The most useful information for changing their attitudes was to increase their understanding of vaccines and informing them about Nagoya city survey results. They mostly wanted a proof of the preventive effects of the vaccine on cervical cancer in Japan.
Conclusion
Gynecologists and pediatricians must proactively communicate accurate scientific information to the government and the media to spread awareness among people in Japan. Also, we must try to demonstrate the capabilities of this vaccine to prevent cervical cancer and/or its precancerous lesions.
Background Soft tissues of the shoulder undergoes substantial stresses due to humeral head movement, and this may contribute to throwing shoulder injuries in baseball pitchers. Prevention and ...management of throwing shoulder injuries critically rely on reduction of shear force at the shoulder joint. However, the amount and direction of the force applied to the shoulder during the throwing motion have not been clarified. The purpose of this study was to analyze forces applied to the shoulder during a baseball pitch. Methods We performed biomechanical analysis of 213 baseball pitchers of various ages and skill levels. Throwing motion was analyzed with a 3-dimensional motion capture system. The Euler angle sequence was adopted to describe angular values of the upper arm relative to the trunk for shoulder rotation, and inverse dynamics was used to estimate the resultant joint forces at the shoulder. Results There was a significant relation between horizontal abduction/adduction angle and resultant anterior/posterior force at the point of maximum external rotation (MER) ( r = −0.63, P < .01), whereby increased horizontal abduction was associated with increased resultant anterior force. There was a significant but weak correlation between abduction/adduction angle and superior/inferior force at MER ( r = 0.24, P < .01). Comparison among the groups with variable ages and skill levels showed larger horizontal abduction and smaller external rotation angles at MER in the adult amateur player group, whereas normalized compression force and internal rotation torque values at MER were smaller in the junior high school– and elementary school–aged groups. Discussion These results suggest that excessive horizontal abduction at MER increases anterior shear force in the shoulder and may lead to shoulder injuries. Focusing on reducing horizontal abduction at MER in the throwing motion may be key to preventing and managing shoulder injuries in baseball pitchers.
