Search Results (8)

Background/Objectives: Type II superior labrum anterior–posterior (SLAP) lesions of the long head of the biceps (LHB) tendon are associated with excessive tendon loading and are commonly treated surgically using SLAP repair, tenotomy, or tenodesis. These procedures alter musculotendinous length and loading and may affect functional outcomes, including forearm supination strength. Appropriate restoration of tendon tension is critical for favorable muscle adaptation and recovery. Shear wave elastography (SWE) is a non-invasive imaging technique capable of quantifying tissue stiffness as a surrogate for in vivo musculotendinous tension. This study aimed to characterize LHB tendon tension across forearm positions and loading conditions to improve the understanding of functional tendon loading relevant to postoperative activation and rehabilitation. Methods: In this controlled laboratory study, thirteen healthy female volunteers without shoulder pathology were assessed using SWE with the elbow positioned at 90° flexion. LHB tendon tension was measured in forearm pronation and supination under passive, active (unresisted), and weighted conditions. Paired t-tests were used to compare forearm positions within each loading condition. Results: LHB tendon tension was significantly greater during active and weighted conditions compared with passive loading in the pronated position (p < 0.05). During active contraction, tendon tension was significantly lower in supination than pronation (p < 0.05), whereas no positional differences were observed under passive or weighted conditions. Relative to passive loading, tendon tension increased by approximately 18.2% and 89.2% in supination, and 67.0% and 97.9% in pronation during active and weighted conditions, respectively. Conclusions: Forearm position selectively influences LHB tendon tension during active, unresisted contraction. Forearm orientation affected LHB tendon stiffness primarily during active, unweighted contraction, where pronation resulted in higher stiffness than supination. On the other hand, stiffness outcomes measured during passive and weighted positions were comparable between forearm orientations, indicating that positional effects are most evident when tendon loading is primarily muscle-driven. These findings highlight the relevance of forearm positioning during early postoperative activation and provide normative in vivo reference data to inform personalized rehabilitation strategies and future investigations of postoperative tendon loading following SLAP lesion treatment. Full article

Background: We assessed intraarticular injuries in patients after primary anterior traumatic shoulder dislocation by comparing magnetic resonance arthrography (MRA) results with concomitant arthroscopic findings. Methods: All patients with primary traumatic shoulder dislocation who underwent arthroscopic surgery between 2001 and 2020 with preoperative MRA were included in this study. MRA was retrospectively compared with arthroscopic findings. Postoperative shoulder function was prospectively assessed using the Disabilities of Arm, Shoulder and Hand score (quick DASH), the Oxford Shoulder Score (OSS), the Subjective Shoulder Value (SSV), as well as the rate of return to sports. Results: A total of 74 patients were included in this study. A Hill–Sachs lesion was consistently found in the corresponding shoulders on MRA and arthroscopy in 35 cases (p = 0.007), a Bankart lesion in 37 shoulders (p = 0.004), and a superior labrum from anterior to posterior (SLAP) lesion in 55 cases (p = 0.581). Of all cases, 32 patients were available for a clinical and functional follow-up evaluation. A positive correlation was found between the level of sport practiced and the Oxford Shoulder Score (redislocation subset) (p = 0.032) and between the age at the time of surgery and the follow-up SSV (p = 0.036). Conversely, a negative correlation was observed between the age at the time of surgery and the Oxford Instability Score (redislocation subset) (p = 0.038). Conclusions: The results of this study show a good correlation between MRA and arthroscopy. Therefore, MRA is a valid tool for the detection of soft tissue pathologies after primary anterior traumatic shoulder dislocation and can aid in presurgical planning. Full article

(1) Background: Patients with a superior-labrum-from-anterior-to-posterior (SLAP) tear associated with a spinoglenoid ganglion cyst have undergone various procedures. The purpose of this study is to evaluate clinical outcomes following arthroscopic treatment in patients with a concomitant spinoglenoid ganglion cyst and SLAP lesion. (2) Methods: This study followed PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines, utilizing the PubMed, EMBASE, Cochrane Library, and Scopus databases. The keywords included shoulder, SLAP, labral tear, spinoglenoid notch, paralabral cyst, arthroscopy, and treatment. (3) Results: A total of 14 articles (206 patients) were included. Repair alone was administered in 114 patients (Group R), and 92 patients underwent additional cyst decompression (Group RD). Both groups showed excellent and similar clinical scores. The rate of the complete resorption of the cyst was 95.5% in Group RD, and 92.2% in Group R. The complication rate was 3.5% in Group RD, and 11.4% in Group R. The reoperation rate was 0% in Group RD, and 5.3% in Group R. (4) Conclusion: Reliable clinical outcomes without serious complications were obtained from the use of both procedures. The decompression of the cyst is a safe method that will alleviate pressure on the suprascapular nerve. Full article

This study investigated the ability of T2 mapping to assess the glenoid labrum and to differentiate between healthy labral substances and superior labral anterior posterior (SLAP) lesions using arthroscopy as the gold standard. Eighteen patients (mean age: 52.4 ± 14.72 years, 12 men) with shoulder pain were examined using 3-Tesla T2 mapping. All the patients underwent shoulder arthroscopy. Using morphological sequences for correlation, regions of interest covering the entire labral substance were placed in the corresponding T2 maps. The diagnostic cutoff values, sensitivities, and specificities, as well as the inter-reader correlation coefficients (ICCs) determined by two independent radiologists, were calculated. The mean T2 value was 20.8 ± 2.4 ms for the healthy labral substances and 37.7 ± 10.63 ms in the patients with SLAP lesions. The maximum T2 value in normal labrum (21.2 ms) was lower than the minimum T2 value in the patients with SLAP lesions (27.8 ms), leading to sensitivities, specificities, and positive and negative predictive values of 100% (95% CI 54.1–100.0) for all the cutoff values between 21.2 and 27.8 ms. The ICCs ranged from 0.91 to 0.99. In summary, the data suggest that evaluation and quantification of the labral (ultra)structural integrity using T2 mapping may allow discrimination between arthroscopically confirmed SLAP lesions and a healthy glenoid labrum. T2 mapping may therefore be helpful in diagnosing patients with suspected labral damage. Full article

Background and Objectives: Shoulder disorders are associated with pain, restricted range of motion and muscular strength, moderate disability and diminished proprioception. This study aimed to compare the effectiveness of an innovative technology-supported and a classical therapist-based proprioceptive training program in addition to conventional physiotherapy, on joint position sense (JPS), pain and function, in individuals with different musculoskeletal shoulder disorders, such as rotator cuff tear, subacromial impingement syndrome and superior labrum anterior and posterior tear. The innovative element of the proprioceptive training programme consists of the use of the Kinesimeter, a device created for both training and assessing shoulder JPS. Materials and Methods: The shoulder JPS test and the DASH outcome questionnaire were applied to fifty-five individuals (28 females, 27 males, mean age 56.31 ± 6.75), divided into three groups: 17 in the conventional physiotherapy group (control group); 19 in the conventional physiotherapy + classical proprioceptive training program group (CPT group); and 19 in the conventional physiotherapy + innovative proprioceptive training program group (KPT group). Assessments were performed before and after a four-week rehabilitation program, with five physiotherapy sessions per week. Results: When baseline and post-intervention results were compared, the value of the shoulder JPS and DASH outcome questionnaire improved significantly for the KPT and CPT groups (all p < 0.001). Both KPT and CPT groups showed statistically significant improvements in JPS, pain and function, compared to the control group which received no proprioceptive training (all p < 0.05). However, the KPT group showed no significant benefits compared to the CPT group. Conclusions: Our findings indicate that using the Kinesimeter device as a novel, innovative proprioceptive training tool has similar effects as the classical proprioceptive training programs among individuals with different non-operated musculoskeletal shoulder disorders such as: rotator cuff tear, subacromial impingement syndrome, and superior labrum anterior and posterior tear. Full article

Cadaver tissue has been identified as the highest-fidelity anatomical representation in terms of the training for orthopedic surgery, including for arthroscopy of a damaged hip labrum. However, hip labrum stiffness in vivo and in cadavers has not been directly compared. The purpose of this study was to compare in vivo and cadaveric hip labrum stiffness during pull-probing with a force sensor. We measured the resistance force of the hip labrum in ten patients during hip arthroscopy (i.e., in vivo) and compared it with ten cadavers, both intact and detached from the acetabulum, using a surgical knife. We confirmed a partial labral tear (i.e., not detached fully from the rim) at an antero-superior potion in all of the patients. The mean highest resistance levels for the hip labrum in the patients (4.7 N) were significantly lower than the intact cadaveric labrum (8.3 N), and slightly higher than the detached labrum (4.2 N). In this study, the stiffness of the cadaveric labrum tissue was similar to that of the in-vivo hip labrum. Full article

Shoulder impingement syndrome causes critical disorders such as rotator cuff tear or superior labrum anterior to posterior (SLAP) lesion in both the general public and in athletes whose sports involve throwing. Nevertheless, the biomechanics of the syndrome still have not been clarified. Contact stress measurement in vivo during shoulder motion is essential to identifying the biomechanics of the syndrome. There have been no reports to date regarding internal impingement syndrome among the syndrome studied by using the finite element method (FEM). The proposed method simulates the internal impingement syndrome according to shoulder motion using the FEM. The method solves the critical process zone error at the supraspinatus tendon insertion according to impingement of the 3D biomechanical model by relaxing the boundary condition for representation of shoulder motion. The simulation results confirmed that the proposed method allowed for the analysis of internal impingement syndrome by measuring contact stress (23.13 MPa) during shoulder motion. The performance of the proposed method was examined through the differential displacement (maximum 3.28 mm) in shoulder motion by boundary condition relaxation. The result of the simulation was consistent with the clinical findings. Full article

The type II superior labrum anterior to posterior (SLAP) repair is a viable option in young and demanding patients, although a prolonged period of pain after surgery is described in the literature. The reason for this fact remains unknown. Thus, the purpose of this study was to investigate the molecular pattern of the biceps tendon anchor, where the sutures for repair are placed. The long head of the biceps tendon (LHBT), including the superior labrum, was dissected in the setting of reverse total shoulder arthroplasty. Immunohistochemical staining was performed using neurofilament (NF) and protein gene product (PGP) 9.5 as general markers for axons and calcitonin gene-related peptide (CGRP) and substance P for nociceptive transmission. A quantitative assessment was performed according to the two regions of interest (ROIs), i.e., the anterosuperior (ROI I) and the posterosuperior labrum (ROI II). Eleven LHBTs with a mean age of 73 years (range: 66–87 years) were harvested intraoperatively. Six LHBTs were gained in osteoarthrosis and five in fractures. We found an inhomogeneous distribution of axons in the anterosuperior and posterosuperior parts of the labrum in all the specimens irrespective of the age, gender, and baseline situation. There was a significantly higher number (p < 0.01) as well as density (p < 0.001) of NF-positive axons in ROI I compared to ROI II. Nociceptive fibers were always found along the NF-positive axons. Thus, our results indicate that the biceps tendon anchor itself is a highly innervated region comprising different nerve qualities. The anterosuperior labrum contains a higher absolute number and density of axons compared to the posterosuperior parts. Furthermore, we were able to prove the presence of nociceptive fibers in the superior labrum. The results obtained in this study could contribute to the variability of pain after SLAP repair. Full article