Search Results (4)

Objective: This study aimed to evaluate, through a network meta-analysis, the short- and long-term efficacy of both Western medical therapies and traditional Chinese medical therapy (acupuncture) in improving symptoms of shoulder pain. Methods: A comprehensive computer-based search was conducted in Embase, Cochrane Library, Web of Science, and PubMed databases for randomized controlled trials (RCTs) related to Western and Chinese medical treatments for shoulder pain measured by visual analogue scale (VAS) scores. All researchers independently screened and selected studies, extracted data, and assessed the risk of bias. Studies that met quality standards were analyzed using Stata 16.0 and Review Manager 5.4 software. Results: A total of 269 articles were retrieved, and 15 were ultimately included in the network meta-analysis, covering nine types of Western and Chinese medical therapies. The total sample size was 1114 cases, with 557 in an experimental group and 557 in a control group. In terms of reducing VAS scores at 4 weeks after treatment, sham acupuncture was significantly less effective than acupuncture (MD: 19.39; 95% CI: 0.66–38.12), indicating that acupuncture had a better short-term effect on pain relief at 4 weeks. In terms of reducing VAS scores at 12 weeks after treatment, sodium hyaluronate (hyaluronate) was more effective than physical therapy (PT) in reducing long-term pain (MD: −19.57; 95% CI: −37.23–−1.90); suprascapular nerve block (SSNB) (MD: −9.11; 95% CI: −16.02–−2.20) and arthroscopic capsular release (MD: −16.07; 95% CI: −30.16–−1.97) were also more effective than PT. The top three treatments in terms of clinical efficacy for painful shoulder conditions were hyaluronate, SSNB, and arthroscopic capsular release. Conclusions: For the treatment of shoulder pain, hyaluronate, SSNB, and arthroscopic capsular release showed greater potential long-term efficacy in pain reduction than PT, with hyaluronate showing the best effect. Full article

In this article, the authors review the role of ultrasound guidance in MSK mini-invasive surgery. Ultrasound imaging has become an important tool in the field of musculoskeletal examination and has advantages over the X-ray guidance traditionally used by orthopaedic surgeons. Ultrasound provides the 3D localization of the area where the instruments are being used, does not require X-ray’s certified personnel, and poses less of a health risk to the patient and the medical staff. This article explores the development and application of ultrasound navigation in mini-invasive surgery, including the use of ultrasound during different stages of arthroscopic procedures or for the entire operation. Ultrasounds can assist in setting access points around the joint, localize the pathology and assure its complete resection, identify vessels and nerves, establish access to and constant control of difficult operating areas with a high potential for neurovascular complications. In this paper, the authors also acknowledge that there are some disadvantages, including the need for additional equipment and personnel, a long learning curve, and the potential elongation of the procedure. To identify all of the essential studies that report relevant information and data concerning the ultrasounds navigation in mini-invasive MSK surgery, an extensive search of the major and significant electronic databases was performed by two authors. An investigation was conducted in January 2023 using the following key terms: ultrasounds navigation, ultrasounds in arthroscopy, ultrasounds in MSK, with no limits regarding the year of publication. The authors focused both on the advantages and disadvantages of ultrasound navigation in MSK mini-invasive surgery, and also on particular techniques in mini-invasive and arthroscopic surgeries. The described techniques are the application of ultrasound in arthroscopy (knee, hip, and shoulder), hallux rigidus surgery, mini-invasive Achilles tendon surgery, gastrocnemius recession, carpal tunnel release, and hematoma evacuation. Full article

Arthroscopic capsular release allows direct visualization and release of inflamed tissues in refractory frozen shoulder. The reticular neural network in the long head of the biceps tendon (LHBT) and nerve endings of the transverse humeral ligament (THL) might be responsible for shoulder pain. We hypothesized that patients with painful refractory frozen shoulder benefited from pan-capsular release, THL release, and LHBT tenodesis. The LHBT tenodesis decreased the possibility of LHBT instability. The balance of the shoulder joint was maintained after such extensive release. From October 2013 to June 2019, patients with painful refractory frozen shoulder were enrolled consecutively at the same institute. All patients received arthroscopic pan-capsular, THL release, and suprapectoral LHBT tenodesis with a minimum of 2-year follow-up. Preoperative and postoperative shoulder range of motion (ROM), pain visual analog scale (PVAS), subjective shoulder value (SSV), constant score, LHBT score, acromio-humeral distance (AHD), and critical shoulder angle (CSA) were recorded. In total, 35 patients with an average age of 53.1 ± 9 years were enrolled. The average follow-up period was 24 ± 1.5 months. Forward elevation improved from 105.1° ± 17° to 147° ± 12° (p < 0.001), external rotation improved from 24.1° ± 13.3° to 50.9° ± 9.7° (p < 0.001), and internal rotation improved from L3 to T9 (p < 0.001), respectively, at final follow-up. PVAS improved from 7.3 ± 1.1 to 1.8 ± 0.6 (p < 0.001), constant score from 23.4 ± 11 to 80.7 ± 5.2 (p < 0.001), and SSV from 27.7 ± 10.5 to 77.4 ± 3.8, respectively, at follow-up. No differences were found in AHD and CSA after surgery (p = 0.316, and p = 0.895, respectively). Patients with painful refractory frozen shoulder benefited from pan-capsular and THL release. A radiographically balanced shoulder joint was maintained even after such extensive release. Full article

Suprascapular neuropathy is an uncommon but increasingly recognized cause of shoulder pain and dysfunction due to nerve entrapment. The aim of this review is to summarize some important aspects of this shoulder pathology. An extensive research was performed on PubMed and Clinical Key. The goal was to collect all the anatomical, biomechanical and clinical studies to conduct an extensive overview of the issue. Attention was focused on researching the state of art of the diagnosis and treatment. A total of 59 studies were found suitable and included. This condition is more frequently diagnosed in over-head athletes or patients with massive rotator cuff tears. Diagnosis may be complex, whereas its treatment is safe, and it has a great success rate. Prompt diagnosis is crucial as chronic conditions have worse outcomes compared to acute lesions. Proper instrumental evaluation and imaging are essential. Dynamic compression must initially be treated non-operatively. If there is no improvement, surgical release should be considered. On the other hand, soft tissue lesions may first be treated non-operatively. However, surgical treatment by arthroscopic means is advisable when possible as it represents the gold standard therapy. Other concomitant shoulder lesions must be recognized and treated accordingly. Full article