Search Results (156)

Background/Objective: Breast cancer-related lymphedema (BCRL) is a frequent postoperative complication associated with shoulder functional impairment. Early diagnosis and comprehensive assessment are recommended, yet the literature shows heterogeneity regarding instrumental tools and the role of soft tissue ultrasound is not yet standardized. The aim of this retrospective observational study is to evaluate correlations between shoulder impairment and lymphedema in breast cancer patients. Methods: Medical records of 27 outpatient women after breast cancer surgery (mean age ± SD: 55.10 ± 9.58) were evaluated. Clinical variables included anamnestic data regarding surgery and oncology treatments, limb circumferences, passive shoulder range of motion (PROM), axillary web syndrome (AWS) and BMI. Assessment tools included DASH, ECOG, and VAS. Millimetric ultrasound measurements of the dermo-epidermal complex and subcutaneous tissue, at standardized sites, were performed to study limb lymphedema. Results: Lymphedema was found in 35.7% of patients. They showed higher rates of lymphadenectomy, AWS, higher BMI, limited shoulder flexion (p = 0.002) and abduction (p = 0.004), and higher DASH scores (31.99 ± 15.70 vs. 26.16 ± 17.8) compared with patients without lymphedema. There was a preliminary correspondence between circumferential and ultrasound measurement sites of patients’ lymphedema limbs. Conclusions: Ultrasound evaluation associated with functional assessment may support the early diagnosis of shoulder impairment and higher limb lymphedema risk to improve rehabilitation treatments in patients after breast cancer surgery. Full article

Effective upper-extremity rehabilitation requires intensive and precise movement training, yet conventional therapies lack accurate motion tracking. Robotic exoskeletons address this limitation but are often hindered by ergonomic misalignment and limited adaptability. The AssistOn-Arm, a novel self-aligning exoskeleton, integrates ergonomic design and back-drivable actuation to enhance comfort and facilitate natural user interaction. This study aimed to assess the usability and ergonomics of the device in healthy participants and to conduct a pilot clinical evaluation in individuals with upper-extremity impairments. Thirty healthy participants and twelve patients with shoulder impairments performed predefined tasks under participant-active and device-active conditions. Kinematic data captured concurrently with AssistOn-Arm and Xsens MVN demonstrated strong agreement between conditions. Quantitative analysis revealed no significant differences (p > 0.05) in flexion, elevation, abduction–adduction, and external rotation, indicating reliable alignment with natural joint axes. Significant differences (p < 0.05) were observed only in sagittal hyperextension and internal rotation, reflecting device mechanical constraints. The study confirms the clinical feasibility of AssistOn-Arm as a sensor-driven, self-aligning exoskeleton that bridges engineering innovation and precision rehabilitation, paving the way for its integration into clinical practice. Full article

Background/Objectives: Hemiplegic shoulder pain (HSP) is a frequent post-stroke complication affecting 30–65% of survivors, contributing to motor dysfunction and reduced quality of life. Balance impairment is another major concern that increases fall risk. This study aimed to examine the associations between HSP, shoulder range-of-motion (ROM) limitations and balance performance using both clinical and sensor-based evaluations. Methods: In this cross-sectional study, 108 stroke survivors (54 with HSP, 54 without) were assessed. Pain intensity was evaluated using the Visual Analog Scale (VAS), balance with the Berg Balance Scale (BBS), and shoulder mobility and postural sway with the validated Euleria Lab IMU-based system integrated with a force platform. Between-group differences were analyzed using the Mann–Whitney U test, and correlations between pain, ROM, balance, and fall-risk indices were determined via Spearman coefficients. Results: Participants with HSP had significantly lower BBS scores (20.96 ± 8.71) than those without HSP (34.58 ± 11.71; p < 0.001). VAS activity scores were negatively correlated with BBS (r = −0.196, p = 0.043) and positively correlated with postural sway and fall-risk parameters, particularly under eyes-closed conditions. Shoulder ROM limitations were linked to poorer balance, and both static and dynamic fall-risk indices were strongly correlated with pain severity (r = 0.676 and r = 0.657; p < 0.001). Conclusions: HSP was associated with impaired balance and elevated fall risk in stroke survivors. The combination of clinical scales and wearable sensor-based measurements provides a comprehensive understanding of postural control deficits. These findings emphasize the need for rehabilitation strategies targeting pain reduction, shoulder mobility, and balance to support functional recovery. Full article

Chronic pain significantly impairs functional performance in patients with cancer. Although acupuncture is effective for cancer-related pain, its impact on pain-related functional interference remains unclear. This secondary analysis of the PEACE randomized clinical trial included patients with prior cancer diagnoses and musculoskeletal pain for ≥3 months. Participants were randomized to groups undergoing 10 weeks of electro-acupuncture, auricular acupuncture, or a waitlist control. Functional performance was assessed using the Quick-Disability Arm/Shoulder/Hand (Q-DASH) for upper limbs and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) subscale for lower limbs (higher scores = worse function). Linear mixed models compared changes over time between groups, with week 12 as the primary endpoint. Functional changes were also compared between pain responders and non-responders in the acupuncture arms. Among 360 patients (mean [SD] age, 62.1 [12.7] years; 69.7% women), mean baseline Q-DASH and WOMAC scores were 33.2 (19.8) and 33.3 (20.3). At week 12, both electro-acupuncture and auricular acupuncture significantly improved function versus waitlist: Q-DASH by −7.18 and −9.64 points, respectively, and WOMAC by −6.89 and −7.61 points (all p < 0.001). No differences were found between the two acupuncture groups. Treatment effects on Q-DASH diminished during follow-up, while improvements on WOMAC persisted. Within the acupuncture groups, pain responders achieved greater functional gains than non-responders (Q-DASH, −6.74; WOMAC, −6.16; both p < 0.001). Electro-acupuncture and auricular acupuncture improved upper and lower extremity function in cancer patients with chronic pain. These findings support acupuncture as a potential adjunct in functional rehabilitation for cancer survivors. Full article

Background: Asymmetrical load carrying can impair balance and increase fall risk, especially in older adults. This study compared postural control in 33 older (mean age 72.2 ± 11.0 years) and 27 younger (mean age 33.5 ± 15.8 years) adults. Methods: Participants performed three 20 s quiet standing trials on a force plate: no load, 3 kg left shoulder load, and 3 kg right shoulder load. Center-of-pressure (COP) variability, range, mean velocity, and sample entropy were computed. This was a quasi-experimental study with a mixed-design ANOVA (Group as between-subjects factor; Load and Plane as within-subjects factors). Results: Younger adults showed better overall stability than older adults across conditions. Older adults had larger COP range than younger adults with no load and with the right-sided load. Notably, no significant difference in COP range was found between groups with the left-sided load. Key statistical findings included the significant Load × Group interaction (F(2, 116) = 3.9, p = 0.024, η_p² = 0.06) for COP range. Conclusions: A small asymmetrical load on the left side may be associated with postural control in older adults, possibly through familiar sensory cues. Conversely, a right-sided load appears to negatively impact their balance. These findings highlight the differential effects of load side on postural control in older individuals. Full article

Background/Objectives: Dupuytren’s contracture is a chronic fibroproliferative disorder of the palmar fascia that leads to progressive flexion deformities and functional impairment. The Southampton Dupuytren’s Scoring Scheme (SDSS) is a disease-specific patient-reported outcome measure designed to quantify disability in this condition. This study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Serbian version of the SDSS. Methods: A cross-sectional study was conducted at the Institute for Orthopedic Surgery “Banjica”, Belgrade, from January 2024 to March 2025. Sixty-eight patients with Dupuytren’s contracture completed the Serbian SDSS, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the 12-Item Short Form Health Survey (SF-12), and a Visual Analogue Scale (VAS) for pain. Translation followed standardized forward–backward procedures. Internal consistency was assessed with Cronbach’s alpha, construct validity with confirmatory factor analysis (CFA), and convergent validity with Pearson’s correlation coefficients. Results: The Serbian SDSS demonstrated excellent internal consistency (Cronbach’s α = 0.914). CFA supported a unidimensional five-item structure with strong factor loadings (0.76–0.93) and acceptable fit indices (χ² = 10.094, df = 5, p = 0.073; IFI = 0.979; CFI = 0.978; TLI = 0.956). Convergent validity was confirmed by strong correlations with DASH (r = 0.779) and VAS (r = 0.702) and a strong negative correlation with SF-12 PCS (r = −0.802). Conclusions: The Serbian SDSS is a valid and reliable instrument for assessing functional disability in patients with Dupuytren’s contracture and offers a robust, patient-centered measure for clinical and research use. Full article

Postoperative C5 palsy is a common complication of cervical spine surgery. Inadequate recovery from C5 palsy can result in significant impairment of activities of daily living. However, no effective treatment has been established for persistent cases. In the present report, we describe a novel therapeutic approach using the Hybrid Assistive Limb (HAL) in a patient with severe, prolonged postoperative C5 palsy. The patient was a 46-year-old man who developed severe right C5 palsy following cervical spine surgery performed 41 months earlier. Despite undergoing conventional rehabilitation, no improvement was observed, and the muscle strength of the right deltoid and biceps remained at manual muscle testing (MMT) grade 2. HAL training, using both shoulder and elbow devices, was initiated at our institution. Training was conducted once weekly for a total of 106 sessions over 21 months. At baseline, the right shoulder range of motion was limited to 50° in flexion and 35° in abduction. With HAL-assisted training, flexion improved to 150° and abduction improved to 95° by the final (106th) session and further increased to 165° and 170°, respectively, at long-term follow-up. Deltoid strength, assessed using handheld dynamometry, increased from 3.5 Nm/kg at baseline to 28.5 Nm/kg after training. In this case, a long-term therapeutic program incorporating shoulder and elbow HAL training successfully improved severe and prolonged postoperative C5 palsy to a functionally useful level. This case highlights the potential effectiveness of HAL therapy for treatment-resistant postoperative C5 palsy. Full article

Background and Objectives: Swimmers are repeatedly exposed to overhead shoulder movements, which overload the surrounding soft tissue and may contribute to shoulder pain. These repetitive demands have also been implicated in the development of scapular dyskinesis (SD). This cross-sectional study aimed to determine the prevalence of SD and to examine its associations with extrinsic and intrinsic factors in adult elite swimmers. Materials and Methods: Fifty competitive swimmers (mean age, 23.9 years; mean training experience, 13.6 years) participated in this study. SD was graded using the Scapular Dyskinesis Test. Extrinsic factors included dominant side, breathing side, years of experience, and primary stroke. Intrinsic factors included Lateral Scapular Slide Test (LSST) distance, pectoralis minor length, glenohumeral internal rotation (IR) range of motion (ROM), shoulder pain, and Penn Shoulder Score. Results: SD was identified in 46% of swimmers. Years of experience and primary stroke showed no significant association with SD; however, obvious SD was observed only in butterfly and freestyle specialists. Increasing SD severity was associated with shorter pectoralis minor length (p < 0.001) and reduced IR ROM (p = 0.013), particularly in the obvious group. Although SD was not related to shoulder pain, it was significantly related to lower Penn Shoulder Scores (p = 0.039). Conclusions: SD is common in adult elite swimmers and is associated with shortened pectoralis minor, reduced IR ROM, and impaired shoulder function, but not to pain. Full article

Background: Spinal epidural abscess (SEA) is a rare but challenging disease. Hyperbaric oxygen therapy (HBOT) is used as an adjunctive therapy for SEA in a limited number of hospitals; however, its efficacy has not been well described. Case: A 70-year-old man presented at our hospital with cervical pain, fever, and impaired right shoulder movement. The patient fell after drinking 17 days prior to the presentation. He was diagnosed with an SEA secondary to a spinal epidural hematoma caused by a prior injury. The patient also had dental caries, and his blood culture was positive for Streptococcus intermedius. We diagnosed the patient with a spinal epidural abscess and hematoma that developed from the caries and the injury. Antibiotics were initiated; however, the motor function gradually worsened, and decompressive surgery was performed. After surgery, neurological impairment persisted, and HBOT was used as an adjunctive therapy. After initiating HBOT, the patient’s arm movements improved, and he was referred to a rehabilitation hospital on day 110 for further rehabilitation. Conclusions: HBOT is increasingly used for spinal cord infections and injuries in a limited number of institutions. It is a potentially effective adjunctive therapy for patients for whom antibiotics and surgery are ineffective. Full article

Frozen shoulder (FS), traditionally regarded as an idiopathic musculoskeletal disorder characterized by pain, stiffness, and capsular fibrosis, is increasingly recognized as the clinical manifestation of systemic endocrine, metabolic, vascular, and immunological dysfunctions. This narrative review reframes FS within a broader neuro–endocrine–immunometabolic model, emphasizing the central role of estrogen deficiency, resistance, and receptor-level disruption, together with their interactions with thyroid dysfunction, endothelial health, and lifestyle-related low-grade inflammation (LGI). Evidence from epidemiological, clinical, and mechanistic studies shows that estrogen signaling failure weakens anti-inflammatory, antifibrotic, and antioxidant defenses, predisposing peri- and postmenopausal women to more severe FS phenotypes. Thyroid dysfunction, particularly hypothyroidism, further contributes to fibrosis and pain sensitization. Endothelial dysfunction—driven by poor diet, advanced glycation end-products (AGEs), and oxidative stress—impairs vascular integrity and promotes local microvascular inflammation. In parallel, lifestyle factors such as sedentarism, circadian misalignment, psychosocial stress, and environmental exposures sustain systemic LGI and hormonal resistance. Together, these interconnected mechanisms suggest that FS is not merely a localized joint pathology but a systemic disorder requiring integrative clinical strategies that combine orthopedic management with endocrine evaluation, metabolic monitoring, dietary interventions, circadian health, and stress regulation. In addition, this review outlines specific clinical implications, highlighting how an integrative, personalized approach that targets hormonal, metabolic, vascular, and lifestyle dimensions may improve pain, function, and long-term prognosis in FS. This paradigm shift underscores the need for future research to focus on stratified patient profiling and interventional trials targeting hormonal, vascular, and lifestyle axes to improve outcomes, particularly in women who remain disproportionately affected by FS. Full article

Individuals with head and neck cancers are living longer than ever before, yet many live with the long-term effects of their cancer and treatment. The purpose of this study was to assess the feasibility of a physiatry assessment clinic (PAC) following neck resection and free flap reconstruction, during which physical function was assessed. Methods: Adult patients participating in a larger prehabilitation study were included. Attendance and the ability to complete the physical function assessment were examined. Exploratory analyses were completed to describe physical function, fitness, shoulder, and neck function among PAC attenders. To further understand PAC feasibility, patient-reported outcomes among PAC attenders and non-attenders were examined over 12 months (QuickDASH, NDII, EAT-10). Results: A total of 36 eligible participants (78.2%) from the larger prehabilitation study were approached to participate in the PAC, and 19 of the 36 attended (52.8%). Participants attended on average 8.6 ± 3.6 weeks post surgery, and 100% were able to complete the functional measures. Exploratory data suggest that those who did not attend (17 of 36 approached) had more advanced disease compared to those who attended (p < 0.05). Patient-reported outcomes suggested better shoulder function and swallow function at 6 months among those who attended the clinic versus those who did not. Conclusions: While recruitment to the PAC and assessment completion demonstrated feasibility, attendance posed challenges for patients. These findings highlight the need for innovative approaches to screening patients and tailoring rehabilitation services based on physical impairment. Full article

Background: Glenoid radiolucenct lines (gRLL) and glenoid component subsidence (gSC) after anatomic total shoulder arthroplasty (aTSA) have traditionally been linked to implant loosening and functional decline. However, their impact on long-term clinical outcomes remains unclear. This study aimed to evaluate whether gRLL and gSC are associated with inferior clinical or functional results in patients without revision surgery. Methods: In this retrospective study, 52 aTSA cases (2008–2015) were analyzed with a minimum of five years of clinical and radiographic follow-up. Based on final imaging, patients were categorized according to the presence and extent of gRLL and gSC. Clinical outcomes included the Constant-Murley Score, DASH, VAS for pain, and range of motion (ROM). Radiographic parameters included the critical shoulder angle (CSA), acromiohumeral distance (AHD), lateral offset (LO), humeral head-stem index (HSI), and cranial humeral head decentration (DC). Group comparisons were conducted between: (1) ≤2 vs. 3 gRLL zones, (2) 0 vs. 1 zone, (3) 0 vs. 3 zones, (4) gSC vs. no gSC, and (5) DC vs. no DC. Results: Demographics and baseline characteristics were comparable across groups. Functional scores (Constant, DASH), pain (VAS), and ROM were largely similar. Patients with extensive gRLL showed reduced external rotation (p = 0.01), but the difference remained below the MCID. Similarly, gSC was associated with lower forward elevation (p = 0.04) and external rotation (p = 0.03), both below MCID thresholds. No significant differences were observed for DC. Conclusions: Neither extensive gRLL nor gSC significantly impaired long-term clinical or functional outcomes. As these radiographic changes can occur in the absence of symptoms, regular radiographic monitoring is essential, and revision decisions should be made individually in cases of progressive bone loss. Full article

Background: Shoulder subluxation and pain are common complications of stroke that impair upper limb function. Objectives: This study conducted a systematic review and network meta-analysis to compare multiple therapeutic interventions for post-stroke shoulder subluxation, establishing an evidence-based hierarchy of treatment efficacy to optimize rehabilitation strategies and guide clinical practice. Methods: A comprehensive search was conducted using the MEDLINE, EMBASE, Cochrane, Scopus, and Web of Science databases until 8 August 2025. Randomized controlled trials evaluating treatments for shoulder subluxation, including neuromuscular electrical stimulation (NMES), Kinesio taping, corticosteroid injections, slings, repetitive peripheral magnetic stimulation, and electroacupuncture, were included. The follow-up duration in the included trials ranged from 1 to 12 weeks. Effect sizes were calculated using standardized mean differences with a random-effects model, and treatment rankings were determined using surface under the cumulative ranking curve (SUCRA). Results: Thirteen studies including 402 patients were analyzed. NMES was the most effective intervention for reducing subluxation distance (SUCRA: 84.9), while corticosteroid injections provided the greatest pain relief at rest (SUCRA: 73.6). Kinesio taping was most effective for functional recovery, as measured by the Fugl–Meyer Assessment (SUCRA: 98.5), and for pain relief during activity (SUCRA: 87.7). Conclusions: Our network meta-analysis suggests that different interventions are optimal for specific aspects of post-stroke shoulder impairment. NMES most effectively reduces subluxation distance, whereas corticosteroid injections are most effective for alleviating pain at rest. Kinesio taping appears superior for enhancing functional recovery and reducing pain during movement. These findings, based on short-term follow-up durations (1–12 weeks), provide an evidence-based ranking of interventions to support multimodal rehabilitation and inform clinical decision-making. The observed heterogeneity across studies underscores the need for standardized treatment protocols and rigorous long-term investigations. Full article

Background: Acromioclavicular joint (ACJ) injuries frequently result from trauma to the shoulder girdle and are particularly common among young, physically active individuals. These injuries account for approximately 9% of all traumatic shoulder girdle injuries and often lead to functional impairment and pain. The TightRope^® system, LARS™ band, and Bosworth screw are among over 160 currently described surgical techniques for managing ACJ dislocations. However, there is no consensus regarding the optimal surgical approach, particularly for the management of moderate Rockwood Type III ACJ dislocations. Materials and Methods: In this retrospective study, data from 246 patients who underwent surgery for ACJ dislocation between 2010 and 2018 at the Department of Orthopedics and Trauma Surgery, Medical University of Vienna, were analyzed. Patients were divided into four cohorts based on the surgical technique used: Bosworth screw, LARS (acute), LARS (chronic), and TightRope. Clinical and radiological outcomes were assessed pre- and postoperatively using the Visual Analog Scale (VAS), Constant, Disability of the Arm, Shoulder and Hand Score (DASH), Simple Shoulder Test (SST), University of California—Los Angeles Shoulder Score (UCLA), Short Form Health Survey (SF-36), and American Shoulder and Elbow Surgeons score (ASES), as well as radiographic analysis. Radiological measurements of the acromioclavicular (AC) and coracoclavicular (CC) joint spaces were taken on both the injured and uninjured shoulders to analyze and compare the reduction in joint gaps. Results: All surgical methods resulted in significant reductions in AC and CC joint gaps. The TightRope and LARS acute groups showed the greatest reductions, with minimal complication rates. Complication analysis revealed significant differences in clavicular elevation (p < 0.001) and CC-ligament ossification (p = 0.006), which were most frequent in the Bosworth group and least common in TightRope^® patients, with LARS showing intermediate values. AC joint arthrosis was uncommon in all four groups and did not differ significantly (p = 0.13). Overall, TightRope^® was associated with the most favorable complication profile. The postoperative VAS score in the TightRope group was 1.52 ± 2.06, and the Constant score was 96.83 ± 5.41, reflecting high patient satisfaction. Conclusions: All systems led to satisfactory radiological and clinical outcomes, with the LARS™ band showing particular effectiveness in chronic ACJ dislocations. While all techniques provided good results, the TightRope^® system demonstrated the most favorable overall profile in our cohort and may therefore be considered a promising contemporary option. Further studies are needed to determine the optimal treatment for moderate ACJ dislocations and to assess the cost-effectiveness of these surgical techniques. Full article

Background/Objectives: Distal adding-on (DA) is a common postoperative phenomenon in Lenke type 2A adolescent idiopathic scoliosis (AIS). Postoperative shoulder imbalance (PSI) is a clinically significant issue following AIS correction, as it may lead to aesthetic dissatisfaction, functional impairment, and reduced quality of life. This study investigated radiographic changes in DA and shoulder balance in Lenke type 2A AIS, particularly focusing on distal wedge angle (DWA) and radiologic shoulder height (RSH) in patients with right sacral slanting (RSS). Methods: We retrospectively analyzed 120 patients with Lenke type 2A AIS who underwent posterior spinal fusion. Patients were grouped by sacral slanting: right (RSS), left (LSS), or none (NS). Radiographic parameters including proximal thoracic curve angle, main thoracic curve angle, DWA, RSH were assessed at multiple time points. Univariate and multivariate linear regression analyses were used to identify factors associated with DA. Results: The RSS group consistently showed the highest DWA and the greatest incidence of DA. RSH initially exceeded the PSI threshold in all groups but decreased to approximately 10 mm by final follow-up. In the RSS group, the inverse relationship between increasing DWA and decreasing RSH was most pronounced. Univariate regression identified postoperative RSH and sacral slanting angle as significant predictors of DWA, though not in the final multivariate model. Conclusions: In Lenke type 2A AIS with RSS, an increasing DWA and decreasing RSH over time suggest that DA may serve as a compensatory mechanism for PSI. Sacral slanting and postoperative RSH may be relevant predictors of this dynamic alignment change. Full article