To find the most effective procedure to treat adhesive capsulitis of the shoulder, we evaluated the clinical effects of an ultrasonographic-guided anterior approach capsular distension and a fluoroscopy-guided posterolateral approach capsular distension. We expected the anterior approach to be better than the posterolateral approach because the rotator interval, a triangular anatomic area in the anterosuperior aspect of the shoulder, which is considered an important component of the pathology of adhesive capsulitis.

PARTICIPANTS WERE RANDOMLY ASSIGNED TO TWO GROUPS: 27 patients in group A were injected by an anterior approach with 2% lidocaine (5 mL), contrast dye (5 mL), triamcinolone (40 mg), and normal saline (9 mL) under fluoroscopic guidance in the operating room. Twenty-seven patients in group B were injected using a posterolateral approach with 2% lidocaine (5 mL), triamcinolone (40 mg), and normal saline (14 mL) under ultrasonographic guidance. After injection, all patients received physiotherapy four times in the first postoperative week and then two times each week for eight more weeks. Treatment effects were assessed using the shoulder pain and disability index (SPADI), visual numeric scale (VNS), passive range of motion (PROM), hand power (grip and pinch) at baseline and at one week, five and nine weeks after injection.

SPADI, VNS, PROM, and hand power improved in one week, five and nine weeks in both groups. Statistically significant differences were not observed in SPADI, VNS, PROM, or hand power between groups.

Ultrasonography-guided capsular distension by a posterolateral approach has similar effects to fluoroscopy-guided capsular distension by an anterior approach.

We present a case of concurrent rotator cuff tear and axillary nerve palsy resulting from anterior dislocation of the shoulder and a large glenoid rim fracture-a "terrible tetrad." A 61-year-old woman fell on her right shoulder. Radiographs showed anterior dislocation of the shoulder with a glenoid rim fracture, and an MRI two months after injury revealed a rotator cuff tear. Upon referral to our hospital, physical and electrophysiological examinations revealed axillary nerve palsy. The axillary nerve palsy was incomplete and recovering, and displacement of the glenoid rim fracture was minimal and already united; therefore, we surgically repaired only the rotator cuff tear three months after injury. The patient recovered satisfactorily following the operation. In patients whose axillary nerve palsy is recovering, surgeons should consider operating on rotator cuff tears in an attempt to prevent rotator cuff degeneration.

We describe the anaesthetic management of arthroscopic repair for complete rotator cuff tear of shoulder in a 59-year-old female with Parkinson's disease (PD) with deep brain stimulator (DBS) using a combination of general anaesthesia with interscalene approach to brachial plexus block. The DBS consists of implanted electrodes in the brain connected to the implantable pulse generator (IPG) normally placed in the anterior chest wall subcutaneously. It can be programmed externally from a hand-held device placed directly over the battery stimulator unit. In our patient, IPG with its leads was located in close vicinity of the operative site with potential for DBS malfunction. Implications of DBS in a patient with PD for shoulder arthroscopy for anaesthesiologist are discussed along with a brief review of DBS.

To compare the quality of life (QoL) in three groups of workers suffering or not from shoulder pain (SP) lasting more than one month during the preceding 12 months.

Between 2002-2005, 3710 workers were randomly included in a French surveillance system of work-related musculoskeletal disorders. In 2007, 2332 responded to a follow-up questionnaire, 2049 were still active. Workers completed the Nordic Questionnaire to assess SP and the SF-36 for QoL. Three groups were defined according to health status at follow-up: Group 1: workers without SP (men: 87.9%; women: 79.2%) Group 2: workers with SP without neck, elbow and hand/wrist pain lasting more than one month during the preceding 12 months (men: 4.2%; women: 6.0%) Group 3: workers with SP and neck, elbow or hand/wrist pain lasting more than one month during the preceding 12 months (men 7.9%; women 14.8%) The mean scores of SF-36 were compared with Kruskall-Wallis test and post-hoc comparisons were performed. Analyses were stratified by gender.

Workers in group 2 had lower scores of physical health compared to workers in group 1, whatever the gender. Workers in group 3 had lower scores of physical and mental health compared to workers in group 1. Two dimensions of mental health in men and the four dimensions of physical health and one dimension of mental health in women had lower scores in group 3 compared to group 2.

Workers with SP and upper-limb pain have poorer QoL compared to workers without SP and workers with SP without upper-limb pain.

Little is known about the influence of occupational mechanical shoulder exposures on the development of acromioclavicular joint degeneration. We aimed to evaluate if arm elevation >90(o), force requirements, and repetitive work are associated with acromioclavicular joint degeneration as assessed by magnetic resonance imaging (MRI).

The study population participated in a study in 2000-2001, where we performed MRI examinations of the right shoulder of 136 right-handed, 40-50 year old men from a historical cohort of machinists, car mechanics, and house painters. In 2011-2012, we re-examined these men. Two radiologists evaluated the images, blinded to exposures status and symptoms. Acromioclavicular joint degeneration was registered in case of subchondral irregularities, joint capsule swelling with adjacent bone marrow oedema and/or subacromial spurs. Cumulative exposures since baseline were obtained by combining self-reported work histories with a job exposure matrix based on expert judgement. We applied multivariable logistic regression adjusted for measured BMI, questionnaire information on smoking, and age.

Of the original population, 129 could be invited, and 90 (70%) participated. Their mean age was 55.1 years (SD 2.8, range 50-60). The prevalence of acromioclavicular joint degeneration was 64% against 43% at baseline. Prevalent MRI findings showed a relation to forceful work: OR 4.0 (95% CI 1.3-12.1). Incident MRI findings were also related to forceful work, without reaching significance. Arm elevation and repetitive work were not associated with the outcome.

Forceful work seems to be a risk factor for acromioclavicular joint degeneration as assessed by MRI at 50-60 years of age.

To evaluate relative contribution of hard manual labour, fluorides' influence, co-morbid pathology on the prevalence and incidence of shoulder pain syndrome (SPS).

One-stage cross-sectional observation of prevalence SPS was investigated. The observed 6094 workers were divided into four groups. The first group was formed by 407 workers of an aluminium plant (elektroliz aluminium), whose professional activity (hard manual labour) is connected the quite big shoulder region loading and fluorides' influence. The 2-nd group consisted of 369 workers with fluorides' influence without manual labour. The 3-rd group consisted of 2078 workers, hard manual labour without influence of bone-seeking toxic factors (metalworker, painters, moulders etc.). The 4-th group - 3240 workers and employees of auxiliary departments not subjected to the influence of unfavourable industrial factors (engineer, command, economists etc.). The observed were divided into four age groups and three working experience groups.

In the observed population the prevalence of SPS was 9,6 (95% CI 8,9-10,7), among male - 8,6 (7,8-9,4), among female - 1,9 (10,5-13,5). The highest rates of SPS were aged 40 to 49 years - 11,0 (9,6-12,4) and older than 50 years - 11,9 (10,5-13,3). The highest prevalence index of SPS were registered in the B first group - 32, 9% (workers exposed to toxic effects of fluoride and physical strain), the lowest - in the 3-rd group - 6,9% (without the impact of toxic action). Rate of shoulder pain prevalence is authentically higher among the workers of hard manual labour and under the toxic influence of fluoride. The prevalence of SP in the 3rd group was similar to the index of the 4th group.

The highest RR of SPS progress was observed in the 1st group in the relation to 4th (5,6) and 3rd groups (5,2), at the same time etiological fraction (EF) was 77.5% and 78,7%, it indicates very high influence of labour conditions on prevalence of SPS. Influence without the manual labour index of RR and EF is much higher in the 2nd group, than in 3rd and 4th groups. It's worth noting that the highest prevalence of SPS was found among patients with broncho-pulmonary system diseases - 24,8 (20,1-29,4), it is higher than among patients with neck pain - 23,4 (21,5-25,3). Among the analysed "nonmanufactoring" data co-morbid pathology of the respiratory system and neck pain increase the risk of the shoulder pain syndrome development. The relative risk of SPS was higher among patients with neck pain (7,0) than with comorbidity of broncho-pulmonary system (2,6).

Although elasticity of the supraspinatus muscle and tendon is a useful parameter to represent the conditions of the supraspinatus muscle and tendon, assessment of the elasticity in clinical settings has not been established. The purpose of this study was to determine the elasticity of the supraspinatus muscle belly and tendon under different muscle contraction conditions using ultrasound real-time tissue elastography (RTE).

Twenty-three healthy individuals participated in this study. Ultrasound RTE was used for elasticity measurements of the muscle belly and tendon of the supraspinatus muscle. The elasticity was defined as the ratio of strain in the tissues to that in an acoustic coupler (reference). A greater ratio indicated that the tissue was softer. Measurements were performed with study subjects in the lateral decubitus position at 10° of shoulder abduction under conditions of (1) no contraction, (2) isometric contraction without a weight, and (3) isometric contraction with a 1-kg weight.

The intraclass correlation coefficient (ICC1,3) of 3 measurements under each condition ranged from 0.931 to 0.998, showing high intraobserver reliability. Strain ratios for both the supraspinatus muscle belly and tendon significantly decreased with increases in muscle contraction (P < .001).

Ultrasound RTE with the acoustic coupler has the potential to noninvasively detect changes in the elasticity of the supraspinatus muscle belly and tendon that accompany varying levels of muscle contraction in clinical practice.

The incidence of reinjuries due to glenohumeral instability and the major risk factors for primary anterior shoulder dislocation in youth rugby players have been unclear.

The purpose of this study was to investigate the incidence, mechanisms, and intrinsic risk factors of shoulder dislocation in elite high-school rugby union teams during the 2012 season.

A total of 378 male rugby players from 7 high-school teams were investigated by use of self-administered preseason and postseason questionnaires.

The prevalence of a history of shoulder dislocation was 14.8%, and there were 21 events of primary shoulder dislocation of the 74 overall shoulder injuries that were sustained during the season (3.2 events per 1000 player-hours of match exposure). During the season, 54.3% of the shoulders with at least one episode of shoulder dislocation had reinjury. This study also indicated that the persistence of glenohumeral instability might affect the player's self-assessed condition, regardless of the incidence during the current season. By a multivariate logistic regression method, a history of shoulder dislocation on the opposite side before the season was found to be a risk factor for contralateral primary shoulder dislocation (odds ratio, 3.56; 95% confidence interval, 1.27-9.97; P = .02).

High-school rugby players with a history of shoulder dislocation are not playing at full capacity and also have a significant rate of reinjury as well as a high risk of dislocating the other shoulder. These findings may be helpful in deciding on the proper treatment of primary anterior shoulder dislocation in young rugby players.

Ossifying tendinitis (OT) is a type of heterotopic ossification, characterized by deposition of hydroxyapatite crystals in a histologic pattern of mature lamellar bone. It is usually associated with surgical intervention or trauma and is more commonly seen in Achilles or distal biceps tendons, and also in the gluteus maximus tendon. To our knowledge, there is no description of OT as a complication of calcifying tendinitis of the rotator cuff. In this report, we describe two cases in which the patients developed an OT of the supraspinatus after arthroscopic removal of calcium deposits. The related literature is reviewed.

The purpose of this study was to prospectively assess the efficacy of arthroscopic repair of isolated high-grade subscapularis (SSC) tendon lesions by means of clinical follow-up combined with magnetic resonance imaging investigations.

Between January 2008 and September 2010, 11 patients (9 men and 2 women; mean age, 45 ± 10 years) with Lafosse type III or IV traumatic isolated SSC tendon lesions underwent arthroscopic repair including tenodesis of the long head of the biceps tendon. All patients were preoperatively assessed by clinical examination (Constant-Murley score [CMS]) and contrast-enhanced magnetic resonance arthrography. At 1 year of follow-up, specific clinical SSC tests, the CMS, and the loss of external rotation were evaluated. A native magnetic resonance investigation was performed to assess the structural integrity of the repair. The SSC muscle was compared with its preoperative condition regarding fatty infiltration and size (cross-sectional area). Patient satisfaction was graded from 1 (poor) to 4 (excellent).

The mean time interval from trauma to surgery was 3.7 months. A concomitant lesion of the biceps tendon was observed in 10 patients (91%). The mean CMS improved from 44 to 89 points (P < .001). The functional tests showed a significant increase in strength (P < .05) (belly-press test, 4.8 v 2.9; lift-off test, 4.8 v 2.9). The mean loss of external rotation at 0° of abduction was 10° compared with the contralateral side (P < .05). Patient satisfaction was high. Magnetic resonance imaging evaluation showed complete structural integrity of the tendon repair in all studies. The SSC showed a significant decrease in fatty infiltration and increase in the cross-sectional area.

Arthroscopic repair of higher-grade isolated SSC lesions provides reliable tendon healing accompanied by excellent functional results 1 year after surgery.

Level IV, prospective therapeutic case series.