Search Results (97)

Background/Objectives: Rotator cuff calcific tendinopathy (RCCT) is one of the most common causes of non-traumatic shoulder pain. To date, there is still no consensus regarding the most effective method for its treatment. Ultrasound-guided percutaneous aspiration is suggested during the reabsorption phase of calcific metaplasia. We aimed to evaluate the effectiveness of ultrasound-guided lavage for RCCT from a clinical and radiological perspective. Methods: We involved patients affected by RCCT of the supraspinatus tendon. The approach used for the calcification lavage was the one-needle technique, consisting in inserting a 16–18 G needle on a 20 mL syringe with 0.9% saline solution, in the calcific metaplasia, under ultrasound guidance, using an in-plane approach; the repetitive action of pressing and releasing the plunger was repeated until the contents of the syringe became milky, at which point the syringe was replaced with a new one, always containing saline solution. The physiotherapy treatment began 7 days after the procedure. We assessed the Numeric Rating Scale, the Gartner classification, the Disability of the Arm, Shoulder and Hand scale, the Constant–Murley shoulder score, and the passive range of motion of flexion and abduction. Results: We included 23 subjects. The analysis of the data at baseline and t1 showed a statistically significant improvement in all the functional variables (p < 0.05). This result was mainly evident for pain, with a p-value of 0.001. Conclusions: The findings of the present prospective case series study showed an improvement in the clinical and radiological outcomes after ultrasound-guided percutaneous aspiration for rotator cuff calcific tendinopathy. Full article

Objectives: This study aimed to investigate the efficacy of Percutaneous Electrolysis (PE), Percutaneous peripheral Nerve Stimulation (PNS), and Eccentric Exercise (EE) in patients with supraspinatus tendinopathy. Methods: Forty-six participants with supraspinatus tendinopathy were randomly allocated to either an invasive therapy group (four sessions in four weeks of PE+PNS and EE program) or a conventional physical therapy group (ten sessions for 2 weeks). The multimodal physical program included Ultrasound therapy (US), Transcutaneous Electric Nerve Stimulation (TENS) and the same EE program. The Numerical Pain Rating Scale (NPRS), shoulder Range of Motion (ROM), Pressure Pain Threshold (PPT), and disability (DASH and SPADI) were measured at baseline, at the end of treatment, and at 12- and 24-weeks follow-up. Results: The PE+PNS+EE group demonstrated consistently greater and statistically significant improvements across nearly all pain, mobility, and functional outcomes at all follow-up points (post-treatment, 12-weeks, and 24-weeks) compared to the TENS+US+EE group, with generally medium to large effect sizes. Conclusions: This study concludes that the combined PE+PNS+EE intervention offers safe and effective treatment for supraspinatus tendinopathy, demonstrating statistically significant improvements in pain, mobility, and function compared to conventional electrotherapy. Full article

Background/Objectives: Hemiarthroplasty (HA) and Reverse Total Shoulder Arthroplasty (RTSA) are both reliable treatment options for complex proximal humerus fractures. The role of the subscapularis tendon is well-defined in HA, whereas it plays a controversial role in RTSA. The purpose of our study is to evaluate its role in patients with proximal humerus fractures treated with HA and RTSA and investigate its association with clinical outcomes. Methods: Sixty-eight consecutive patients with proximal humeral fracture were prospectively enrolled into the study from June 2015 to May 2020 (RTSA = 36; HA = 32). Pre- and postoperative shoulder CT scans were performed to measure the subscapularis muscle cross-sectional area (SMCSA) and the supraspinatus fossa cross-sectional area (SFCSA). The SMCSA/SFCSA ratio was employed to normalize measurements against individual patient anatomy. Patient reported outcomes (PROs) and range of motion (ROM) were evaluated at the final follow-up. Results: The RTSA group demonstrated superior patient-reported outcomes (PROs) and range of motion (ROM) compared to the HA group. Notably, the Constant Score was significantly higher in the RTSA group (58.00 vs. 38.50; p = 0.0001), as well as forward flexion (147.50° vs. 90.00°; p < 0.0001). A postoperative reduction in subscapularis size of >35% occurred more frequently in RTSA patients (55.6%) than in HA patients (25%) (p = 0.01). The loss of subscapularis surface was greater in the RTSA patients (p = 0.018). Conclusions: RTSA demonstrated better results compared to HA, providing better ROM and PROs. Postoperative reduction in subscapularis size was significantly higher in RTSA compared to HA. Subscapularis condition seems to show no correlation with functional outcome in RTSA. Full article

Background and Objectives: CrossFit is a discipline involving a wide range of overhead movements performed at high intensity and under accumulated fatigue that predispose to a high risk of shoulder complex injuries. This study aimed to compare ultrasonographic findings between symptomatic and asymptomatic shoulders in CrossFit athletes. Materials and Methods: A cross-sectional study was conducted to compare ultrasound parameters between the painful and non-painful shoulders in CrossFit athletes with unilateral subacromial shoulder pain. Assessed variables included subacromial subdeltoid bursa thickness, supraspinatus tendon thickness, the acromiohumeral distance, the coracoacromial ligament distance, the bicipital groove angle, cross-sectional area of the biceps brachii longus head tendon, as well as the serratus anterior and lower trapezius muscle thickness. Results: Twenty male CrossFit athletes (forty shoulders) with an average age of 25.70 ± 4.03 years participated in the study. A statistically significant increase was observed (p < 0.05) in the subacromial subdeltoid bursa thickness in the painful shoulder compared to the asymptomatic side. All other ultrasound parameters did not show statistically significant differences. Conclusions: Only subacromial subdeltoid bursa thickness differed significantly between sides. This isolated finding may not fully explain shoulder pain, which cannot be solely attributed to morphological changes. Further research is needed to determine the relationship between shoulder pain and ultrasound features in CrossFit athletes, as well as the role of ultrasound in predicting structural changes in pain conditions. Full article

Rotator cuff tears are a leading cause of shoulder pain and dysfunction, yet the molecular mechanisms that link tendon injury to inflammation and nociceptive signaling remain poorly understood. Netrin-1, a classical axon guidance cue signaling through dependence receptors UNC5B and Neogenin-1, has been implicated in both neuronal plasticity and inflammatory processes, but its role in tendon pathology has not been explored. A rat supraspinatus tear model was employed to assess, in vivo, the expression of genes encoding netrin-1 (Ntn1) and its receptors (Unc5b and Neo1) at 0, 7, 14, 28, and 56 days post-injury (n = 10 per time point). Primary rat tenocytes isolated from rotator cuff tissue were treated in vitro with recombinant netrin-1, and transcriptional changes in genes encoding TNF-α (Tnfa), IL-6 (Il6), MMP-1 (Mmp1), and MMP-3 (Mmp3) were quantified by qRT-PCR. Separately, human iPSC-derived sensory neurons were exposed to netrin-1, and dose- and time-dependent effects on neurite outgrowth were measured at 4 and 14 days in culture. In injured tendons, Ntn1 mRNA increased significantly at day 14 (p = 0.010) and 28 (p = 0.042), Unc5b at day 7 (p = 0.002) and 14 (p < 0.001), and Neo1 at day 14 (p < 0.001) versus intact controls. Tenocyte exposure to 500 ng/mL netrin-1 induced transient upregulation of Tnfa (3 h, p = 0.023; 6 h, p = 0.009) and Il6 (3 h–24 h, all p < 0.013), as well as Mmp3 (3–24 h, p < 0.043) and Mmp1 (6 h–24 h, p < 0.024); no induction was observed at 50 ng/mL. In sensory neurons, 50 ng/mL of netrin-1 enhanced neurite extension at day 4 (p = 0.006) but not at 500 ng/mL or at day 14 for either dose. Netrin-1 and its receptors are upregulated in a rat rotator cuff tear model, and netrin-1 elicits distinct pro-inflammatory and matrix-remodeling responses in tenocytes while promoting early neurite growth in sensory neurons. These findings suggest netrin-1 as a key modulator of tendon inflammation, matrix turnover, and peripheral nerve plasticity following injury. Full article

Objective: This descriptive systematic review aimed to assess in the available literature on the current application and overall performance of Artificial Intelligence (AI) models in the diagnosis and classification of Rotator Cuff Tears (RCTs) using MRIs. Methods: The systematic review was performed by two of the authors from 2020 to November 2024. Only diagnostic studies involving AI application to MRI images of the rotator cuff were considered, including supraspinatus and biceps tears. Studies evaluating AI applications to Ultrasound or X-ray, or including only healthy rotator cuffs, were not analyzed in this paper. Results: The coronal plane in the T2 sequence emerged as the predominant imaging protocol, with the VGG network being the most widely utilized AI model. The studies included in this research exhibited a solid performance of the AI models with accuracy, ranging from 71.0% to 100%. The statistical analysis revealed no significant differences (p > 0.05) in accuracy, sensitivity, specificity, or precision between AI and human experts across studies that included such comparisons. Conclusions: While AI can significantly improve diagnostic efficiency and workflow optimization, future studies must focus on external validation, regulatory approval, and AI-human collaboration models to ensure safe and effective integration into orthopedic imaging. Full article

Background/Objectives: Calcific tendinopathy of the shoulder is a degenerative condition characterized by calcium deposits within the rotator cuff tendons, particularly the supraspinatus. It is a frequent cause of chronic shoulder pain and functional limitation, adversely affecting quality of life. While conservative treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs), physiotherapy, and corticosteroid injections are commonly used, extracorporeal shock wave therapy (ESWT) has emerged as a promising non-invasive alternative. This interventional clinical trial compared the efficacy of ultrasound-guided versus landmark-based ESWT in treating calcific tendinopathy. Methods: Eighty-four patients with ultrasound-confirmed calcific tendinopathy were randomized into two groups. Group 1 received ultrasound-guided ESWT with real-time targeting of the deposit; Group 2 received landmark-based ESWT based on anatomical palpation. Both groups underwent three sessions (2000 impulses at 2.2 bars, energy level 5, 8 Hz). Clinical outcomes were assessed using the Constant–Murley score (CMS) at baseline, 12 weeks, and 6 months. Calcific deposit resorption was evaluated via ultrasound imaging. Results: The ultrasound-guided group showed a significant improvement in CMS from a median of 50 (range: 30–75) at baseline to 97 (52–100) at 6 months. The landmark-based group also improved, from 48 (32–74) to 79 (40–96). At 6 months post-treatment, 90.9% of patients in the ultrasound-guided group achieved successful outcomes (CMS ≥ 86), compared to 50% in the landmark-based group. Complete calcific resorption occurred in 65.9% of patients in Group 1, compared to 50% in Group 2; 15% of patients in Group 2 showed no resorption. Conclusions: Ultrasound-guided ESWT was significantly more effective than landmark-based ESWT in improving shoulder function, reducing pain, and promoting calcific deposit resorption. These findings support ultrasound guidance as a preferred approach for optimizing ESWT outcomes in patients with calcific tendinopathy of the shoulder. Full article

Objective: This prospective study aims to investigate the feasibility of Shear-Wave Elastography (SWE) for assessing the mechanical properties of the normal supraspinatus tendon and describing the elastographic features of the supraspinatus tendon under different loading conditions and positions. Methods: Twenty healthy volunteers (10 males and 10 females, aged 18–25 years) were examined by SWE using an 18-4 MHz linear array transducer. The elasticity of the supraspinatus tendon of the dominant hand was measured at three distinct locations: the insertion, middle, and myotendinous junction of the tendon. These measurements were taken under various conditions, including non-loading and the application of 5, 10, and 20 lb forces at five different positions. Results: The average elasticity was 69.2 ± 26.5 kilopascals across all positions and forces, with the middle part of the tendon exhibiting the highest elasticity (72.6 ± 6.2 kPa). An ascending trend in elasticity was observed by increasing the applied load, and the highest elasticity was observed with a 20 lb load. Determining the normal elasticity of the tendon is an important clinical implication, as understanding what is normal is essential for identifying pathological conditions. Conclusions: SWE is a feasible and promising technology for the collection of data on how the supraspinatus tendon behaves under loading conditions. There is a need for further study to better understand tendon response to activity and resultant injuries. Full article

Background: The coracohumeral ligament (CHL) is inserted in the coracoid process, from which it extends laterally and caudally, blending with the tendinous insertions of the subscapularis muscle and the supraspinatus muscle, with a third intermediate area between the muscles inserted between the humeral tubercles, and it contributes to the fibrous tunnel that engulfs the long head of the biceps tendon. Most previous studies mention insertions from the base of the coracoid process, but not from the tip, and some authors describe anterior and posterior columns. In contrast, others stress the existence of superficial and deep fascicles. Also, the relationship between the coracohumeral and the glenohumeral ligaments is unclear. Given the position of the CHL covering most of the rotator interval, and its role in the stability of the shoulder capsule and pathologies like frozen shoulder, a clear description of its fascicles in a plane-wise manner might be helpful for a selective surgical approach. Methods: We studied sixteen soft-embalmed shoulders to avoid misclassifying fascicles due to formalin-linked tissue amalgamation. Further histological assessment was performed on the two remaining non-embalmed shoulders. Results: In our sample, the coracohumeral ligament hung from the anterior and posterior edges of the coracoid process’ inferior surface, defining two columns that converged near the tip of the coracoid process. Both columns were formed by superficial and deep fascicles directed to different depths of the rotator cuff, usually via the rotator interval, fusing with the connective tissue around the muscles without direct distal attachments. We performed histological and morphometrical assessments, and we discuss clinical and biomechanical implications. Conclusions: The coracohumeral ligament contains four fascicles that fuse with the connective tissue of the shoulder joint, forming a double necklace around the subscapularis and supraspinatus. Therefore, its functions probably extend beyond simple vertical stabilization. Full article

Background: Quantitative magnetic resonance imaging (MRI) techniques such as T₂ mapping may detect early tendon changes following biologic therapies. This study aimed to assess the structural remodeling of the supraspinatus tendon using mean T₂ values and T₂ distribution profiles after an ultrasound (US)-guided single platelet-rich plasma (PRP) injection. Methods: Twenty-six patients with symptomatic supraspinatus tendinopathy were divided into tendinosis (n = 9) and partial tear (n = 13) groups. T₂ mapping and clinical evaluations (shoulder pain and disability index questionnaire (SPADI), Constant-Murley score) were conducted at baseline and 6 months post-PRP. Mean T₂ values were measured in three tendon segments (lateral, middle, and medial), and T₂ profiles were compared to asymptomatic controls. Results: Clinical outcomes showed significant improvement in both the tendinosis and partial tear groups at the 6-month follow-up. Although no significant changes were observed in the mean T₂ relaxation times across tendon segments following PRP treatment, T₂ distribution profiling revealed statistically significant alterations in both groups. In the tendinosis group, post-treatment T₂ profiles approached those of the asymptomatic controls, suggesting structural remodeling consistent with tendon healing. Conclusions: T₂ mapping is an effective tool for detecting tendon remodeling following PRP therapy. Structural improvements indicative of tissue healing were observed in cases of tendinosis, but not in partial tendon tears. These findings support the use of T₂ mapping—particularly the T₂ distribution profiling—as a quantitative biomarker for assessing treatment response to PRP. Full article

Background: Ozone therapy is used for its immunomodulatory, antioxidant, and analgesic properties in several fields. It can be useful in the rehabilitation of musculoskeletal disorders. Studies showed that O₂-O₃ therapy can reduce pain and improve functioning in patients affected by low back pain and knee osteoarthritis. Only a few studies have been published about the efficacy of this treatment in upper limb disease. Objective: The aim of this study is to investigate the use of ozone therapy in upper limb pathologies, evaluating its quantity, quality, and reported results in upper limb musculoskeletal disease, supraspinatus tendinopathy, shoulder impingement, adhesive capsulitis, chronic epicondylitis, and carpal tunnel syndrome. O₂-O₃ reduces inflammation by stimulating anti-inflammatory cytokines and inactivating pro-inflammatory molecules, relieves pain by interacting with pain receptors and improving blood circulation, promotes the regeneration of damaged tissues by stimulating growth factors and improving vascularization, and, finally, activates endogenous antioxidant defense systems by protecting cells from oxidative damage. Methods: A comprehensive search was conducted on PubMed and Scopus using the following MeSH terms: ozone therapy, infiltration joint, musculoskeletal disease, rehabilitation, upper limb, shoulder, wrist, hand, elbow, including English papers published in the last five years. Results: Five papers have been selected: four randomized controlled trials and one retrospective cohort study. The RCTs compared the effectiveness of intra-articular ozone injection with steroid injection alone or with other conservative treatments in shoulder diseases; one paper studied the effectiveness of ozone injection and orthoses in carpal tunnel syndrome compared to orthoses alone; one paper used ozone injections compared with steroid injection in patients with chronic lateral epicondylitis. A total of 218 patients were studied in these trials. Conclusions: Ozone treatment seemed to improve pain and function as well as other therapies in upper limb musculoskeletal disease. However, the trials’ protocols and the upper limb areas treated are different. Further studies are needed to define the effectiveness of ozone therapy in upper limb diseases in rehabilitation fields. Full article

Background/Objectives: This study aimed to identify the risk factors for retears after arthroscopic rotator cuff repair (ARCR) and to establish a hierarchy of their importance using machine learning. Methods: This study analyzed 788 primary ARCR cases performed by a single senior surgeon from January 2016 to December 2022. The condition of the repaired supraspinatus was assessed via magnetic resonance imaging (MRI) or sonography within 2 years after surgery. In total, 27 preoperative demographic, objective, and subjective clinical variables were analyzed using five well-established models: Extreme Gradient Boosting (XGBoost), Random Forest (RF), Support Vector Machine (SVM), Neural Network (NN), and logistic regression (LR). The models were trained on an 8:2 split training and test set, with three-fold validation. The primary metric for evaluating model performance was the area under the receiver operating characteristic curve (AUC). The top five influential features were extracted from the best-performing models. Univariate and multivariate LRs were performed independently as a reference. Results: The overall retear rate was 11.9%. The two best-performing prediction models were RF (validation AUC = 0.9790) and XGBoost (validation AUC = 0.9785). Both models consistently identified the tear size in the medial–lateral (ML) and anterior–posterior (AP) dimensions, full-thickness tears, and BMI among the top five risk factors. XGBoost uniquely included female sex, while RF highlighted the visual analogue scale (VAS) pain score. While conventional univariate regression indicated multiple significant factors associated with retears (age, full-thickness tear, AP and ML tear size, biceps conditions, fatty infiltration of three rotator cuff muscles, and atrophy of supraspinatus), multivariate analysis demonstrated that only age and the ML tear size are significant factors. Conclusions: Machine learning models demonstrated enhanced predictive accuracy compared to traditional LR in predicting retears, and the importance of risk factors was derived. Tear size, full-thickness tears, BMI, female sex, and VAS pain score emerged as the most influential risk factors. Full article

There is growing interest among consumers in the nutritional value of the food they consume. The objectives of this study were (1) to document the nutritional value, with a focus on the fatty acid profile, of beef from cattle from one commercial production system that only ever received grass-based feed ingredients compared with similar animals finished in more conventional, i.e., with high-concentrate or concentrate-supplemented grass silage, production systems; (2) to determine the effect of the dietary treatments on muscles representing a range in intramuscular fat concentrations and commercial value, viz supraspinatus, semitendinosus, longissimus lumborum and psoas major; and (3) to determine if the fatty acid profile can be used to distinguish between different beef muscles. Dietary treatment and muscle type influenced the concentration of omega-3 polyunsaturated fatty acids and conjugated linoleic acid, with the highest concentrations observed in psoas major from cattle fed grass only. These data should be of use to the meat industry and to those updating nutritional databases. The possibility of discriminating beef according to its dietary background based on the fatty acid profile was confirmed. While this approach was moderately successful with respect to the separation of supraspinatus, longissimus lumborum and psoas major, discrimination between the more valuable longissimus lumborum and the lower-value semitendinosus is more challenging. Full article

Background/Objectives: Plain radiography is the primary diagnostic tool for calcific tendinitis of the shoulder. Several qualitative grading methods have been proposed to represent the pathophysiologic phase and guide treatment decisions. However, these methods have demonstrated low reliability, complicating their effectiveness for such purposes. This study aims to perform the first quantitative analysis of calcific lesions using radiographic imaging and explore their correlation with ultrasonographic parameters to enhance their diagnostic utility. Methods: A total of 57 shoulders presenting with painful calcific tendinitis in either the supraspinatus or subscapularis tendon were reviewed. The calcific deposits and tendon regions of interest were meticulously identified and annotated. Image brightness was reduced to 256 grayscale levels, and descriptive and heterogeneity parameters, including skewness, kurtosis, complexity, and entropy, were quantified and analyzed. Results: In the region of calcification, the average grayscale values were 21.69 units higher than those of tendon tissue. All spatial heterogeneity parameters, except for skewness, demonstrated statistically significant differences when compared with the adjacent tendon. Notably, entropy and complexity were the most distinctive features, with an area under the curve of 0.93 and cut-off values of 4.62 and 4.18, respectively. Significant correlations were observed between the heterogeneity parameters and ultrasonographic findings, such as bursal contact and peri-calcific hypoattenuation. Conclusions: Calcific deposits demonstrated not only increased brightness in grayscale levels but also distinct spatial heterogeneity. The correlation with ultrasonographic findings indicates that these heterogeneity parameters may reflect underlying pathophysiological characteristics. Future prospective research could explore the whole temporal changes of calcifications more thoroughly. Full article

Background/Objectives: In the shoulder region, shear wave elastography (SWE) has been used to obtain data from multiple muscles. However, there is still a lack of evidence regarding normative values for the supraspinatus muscle. The aim of this study is to estimate the range of normative values and to evaluate the relationship between SWE measurements and isometric strength. Methods: A cross-sectional study with 46 healthy subjects was conducted. Data regarding the SWE of supraspinatus muscle at rest and during contraction and isometric elevation strength were collected. Ordinal cumulative probability models were implemented to calculate normative values based on age and sex. Results: There was a significant increase in muscle stiffness from rest to contraction (3.97; 95% CI, 3.52 to 4.43), but there were no differences between males and females. The ordinal regression models showed a relationship between age and SWE at rest (coefficient, 0.08; 95% CI, 0.01 to 0.14), but not during contraction, and there was no significant age–sex interaction. Normative values of the median and 25th and 75th percentiles were provided based on individuals’ age and sex. There was no correlation between SWE measurements and strength values. Conclusions: Normative values for supraspinatus muscle SWE measurements at rest and during contraction were obtained. These data can help clinicians to interpret measurements of their patients with shoulder disorders. Full article