Adult ; Diagnostic Errors ; Femur ; Humans ; Male ; Osteomyelitis ; diagnosis ; Suppuration ; Tuberculosis, Osteoarticular ; diagnosis

BACKGROUNDShoulder immobilization can induce adhesion of the joint, capsular contracture or lead to the condition of frozen shoulder. However, little is known about the histological effects of immobilization on the shoulder joint. This study aimed to explore the effect of immobility on the subscapular bursa (SSB) and the joint capsular content, including the distribution of types I and III collagen, within an immobilized rat shoulder.

METHODSForty-six Sprague-Dawley rats were randomly divided into one control group (n = 6) and four immobilization groups (n = 10 in each group), in which the left shoulders were immobilized with plaster for 1, 2, 3 and 4 weeks. At the end of each time point, 2 rats from each group were euthanized and shoulders prepared for serial histological observations of the glenohumeral joints, as well as picrosirius red and immunohistochemical observation of type III collagen. Histological sections of the remaining rat shoulders were used for the immunohistochemical detection of the capsular content of types I and III collagen.

RESULTSThe hyperplastic synovium of the anterior capsule obstructed the communication between the SSB and the glenohumeral joint cavity at 2 and 3 weeks. The adhesion of the SSB appeared at 3 and 4 weeks. The quantitative and qualitative results showed that the capsular contents of types I and III collagen progressively increased at 2, 3 and 4 weeks, and that type III collagen was distributed extensively within the joint capsule at 2 and 3 weeks.

CONCLUSIONImmobilization of the rat shoulder induced synovial hyperplasia of the joint capsule, adhesion of the SSB and an increase of the capsular content of types I and III collagen.

Animals ; Collagen ; metabolism ; Disease Models, Animal ; Immunohistochemistry ; Joint Capsule ; metabolism ; Male ; Rats ; Rats, Sprague-Dawley ; Shoulder Dislocation ; metabolism ; pathology ; Shoulder Joint ; metabolism ; pathology

OBJECTIVETo investigate the effect of the arthroscopic procedure on the patients with recurrent anterior shoulder dislocation.

METHODSFrom January 2001 to March 2006,52 patients with recurrent anterior shoulder dislocation were treated by arthroscopy. Among them 44 patients were followed up for 12 to 54 months(on average of 26 months). The data of the 44 patients was reviewed. Three evaluation systems, University of California at Los Angeles Shoulder Scores (UCLA), Simple Shoulder Test (SST) and Dawson, were used. The study evaluated the effect based on the Dawson system by the factors as: age, course of the disease, frequency of dislocation and relocation methods and the range of shoulder movement.

RESULTSThe ratio of recurrent dislocation after operation was 4.5%. Assessing through 3 evaluation systems, UCLA, SST and Dawson, results were similar: the follow-up evaluation were extraordinarily different from preoperative assessment, and the rating of good or excellent at the time of the final follow-up reached 91% higher. Based on the Dawson system, the evaluation results had no statistic diversity according to such factors as: age, course of the disease, frequency of dislocation and relocation methods.

CONCLUSIONSThe effects of arthroscopic surgery to the recurrent anterior shoulder dislocation are satisfied and evidence-proved. It is a good option for both common patients and athletes.

Adolescent ; Adult ; Arthroscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Radiography ; Recurrence ; Retrospective Studies ; Shoulder Dislocation ; diagnostic imaging ; surgery ; Treatment Outcome

BACKGROUNDThe deltoid contracture is an uncommon disorder. Long-standing contracture produces winged scapula, abduction and extension contracture of the shoulder. Surgical release has been considered the treatment of choice. However, the method of approach has not been well defined. The purpose of this study was to evaluate the results of arthroscopic release of the deltoid contracture.

METHODSA retrospective study was undertaken to evaluate the results of arthroscopic release in six patients (seven shoulders) who had a contracture of the deltoid muscle. All patients had arthroscopic release. The abduction-contracture and horizontal-adduction angle was measured after operation. The average duration of follow-up was 16 months (range, from 4 to 41 months).

RESULTSThe preoperative abduction contracture resolved completely in three shoulders. Two had a residual abduction contracture of 5° to 7° and two had a poor result with 15° abduction-contracture angle. The average postoperative abduction-contracture angle was 6° (range, 0° to 15°). The preoperative horizontal-adduction contracture was corrected, permitting at least 130° of adduction, in five shoulders. The remaining two shoulders had a postoperative horizontal-adduction angle of 120° and 110°. Overall, the average postoperative horizontal-adduction angle was 130° (range, 110° to 140°).

CONCLUSIONArthroscopic release is an effective surgical technique to treat the deltoid contracture.

Adolescent ; Adult ; Arthroscopy ; methods ; Child ; Contracture ; surgery ; Deltoid Muscle ; surgery ; Female ; Humans ; Male ; Retrospective Studies ; Young Adult

BACKGROUNDArthroscopic debridement is an appropriate procedure for osteoarthritic elbow in general populations. However, the results of arthroscopic debridement in the professional athletes, a younger and highly active patient cohort is unclear. The purposes of this study were to assess the clinical outcomes of arthroscopic debridement of osteoarthritic elbow in professional athletes and to evaluate the effect of prognostic factors on the clinical outcomes.

METHODSFrom January 1999 to January 2006, 35 professional athletes with osteoarthritc elbow (36 elbows) were treated with arthroscopic debridement, consisted of osteophytes removal, loose bodies removal and fenestration of the olecranon fossa as necessary. Average patient age was (23 ± 5) years (range 7 - 34 years). Average follow-up was (43 ± 23) months (range 16 - 98 months). Athletic activities consisted mainly of wrestling, judo and weightlifting. Patients were evaluated preoperatively and postoperatively with the modified Hospital for Special Surgery (HSS) elbow scoring system.

RESULTSAccording to the modified HSS elbow scoring system, the result was excellent for 16 elbows, good for 14 and poor for 6. No case had got worse after surgery. All athletes reported an improvement in pain. After athletic training, 15 elbows were not painful, 16 mildly painful, 3 moderately painful and 2 severely painful. The arc of flexion-extension improved from 111° preoperatively to 127° postoperatively. All of the athletes were able to return to their previous level of training. Five athletes won national-level championships. At follow-up, 17 athletes (18 elbows) were greatly satisfied with the results, 12 satisfied and 6 unsatisfied. Postoperatively, one athlete reported ulnar nerve symptoms and two others had residual loose bodies. The fenestration of the olecranon fossa was associated with a significantly increased chance of a poor outcome. The nature of the osteoarthritis, duration of symptoms, osteophytes removal and loose bodies removal did not predict the outcomes.

CONCLUSIONSArthroscopic debridement of osteoarthritic elbow in professional athletes can yield significant short-term pain relief, as well as restoration of elbow range of motion and resuming their athletic training. The long-term durability of this procedure with regard to preservation of range of motion and radiographic progression of arthritis remains unknown.

Adolescent ; Adult ; Arthroscopy ; methods ; Child ; Debridement ; methods ; Elbow Joint ; surgery ; Female ; Humans ; Male ; Osteoarthritis ; surgery ; Young Adult

OBJECTIVETo evaluate the posterior and superior compression test (PSCT) and weight-bearing on elbow test (WBE) on the diagnosis of superior labrum anterior to posterior (SLAP) lesion.

METHODSFrom July 2000 to March 2007, 4 clinical tests including O'Brien test, Crank test, PSCT and WBE were randomly performed on 207 patients (209 shoulders). Among the patients, 125 were males and 82 were females with the mean age of 39 years. All the patients underwent arthroscopic treatment by the same doctor. The arthroscopic diagnosis was considered as the golden standard. For each test, the parameters on clinical epidemiology were calculated, and the differences of detection rate between the physical tests and the arthroscopic examination were compared.

RESULTSThe parameters on clinical epidemiology of O'Brien test, Crank test, PSCT and WBE were comparable. The difference of detection rate between the physical tests and the arthroscopic examination was not statistically significant (P > 0.05). The detection rates of PSCT and WEB in the group of injury of posterior and superior labrum were statistically higher than the group of injury of anterior and superior labrum. The detection rate of PSCT in the group of simple SLAP lesion was relatively higher.

CONCLUSIONSCompared with O'Brien test and Crank test, the new PSCT and WBE have not only comparable clinical value in the diagnosis of SLAP lesion, but also the advantage in predicting the location of SLAP lesion. The detection rate of PSCT in the group of simple SLAP lesion is relatively higher, but the mechanism is to be determined.

Adolescent ; Adult ; Aged ; Arthroscopy ; Elbow Joint ; injuries ; physiopathology ; Exercise Test ; methods ; Female ; Humans ; Male ; Middle Aged ; Shoulder Dislocation ; diagnosis ; physiopathology ; Shoulder Joint ; injuries ; physiopathology ; Weight-Bearing

BACKGROUNDThe supraspinatus tendon is the most commonly affected tendon in rotator cuff tears. Early detection of a supraspinatus tear using an accurate physical examination is, therefore, important. However, the currently used physical tests for detecting supraspinatus tears are poor diagnostic indicators and involve a wide range of sensitivity and specificity values. Therefore, the aim of this study was to establish a new physical test for the diagnosis of supraspinatus tears and evaluate its accuracy in comparison with conventional tests.

METHODSBetween November 2012 and January 2014, 200 consecutive patients undergoing shoulder arthroscopy were prospectively evaluated preoperatively. The hug-up test, empty can (EC) test, full can (FC) test, Neer impingement sign, and Hawkins-Kennedy impingement sign were used and compared statistically for their accuracy in terms of supraspinatus tears, with arthroscopic findings as the gold standard. Muscle strength was precisely quantified using an electronic digital tensiometer.

RESULTSThe prevalence of supraspinatus tears was 76.5%. The hug-up test demonstrated the highest sensitivity (94.1%), with a low negative likelihood ratio (NLR, 0.08) and comparable specificity (76.6%) compared with the other four tests. The area under the receiver operating characteristic curve for the hug-up test was 0.854, with no statistical difference compared with the EC test (z = 1.438, P = 0.075) or the FC test (z = 1.498, P = 0.067). The hug-up test showed no statistical difference in terms of detecting different tear patterns according to the position (χ2 = 0.578, P = 0.898) and size (Fisher's exact test, P > 0.999) compared with the arthroscopic examination. The interobserver reproducibility of the hug-up test was high, with a kappa coefficient of 0.823.

CONCLUSIONSThe hug-up test can accurately detect supraspinatus tears with a high sensitivity, comparable specificity, and low NLR compared with the conventional clinical tests and could, therefore, improve the diagnosis of supraspinatus tears in clinical settings.

Adolescent ; Adult ; Aged ; Diagnostic Tests, Routine ; methods ; Female ; Humans ; Male ; Middle Aged ; Rotator Cuff ; pathology ; Rotator Cuff Injuries ; diagnosis ; Tendon Injuries ; diagnosis ; Young Adult

OBJECTIVETo evaluate retrospectively the results of arthroscopic Bankart repair using suture anchors for recurrent anterior shoulder dislocation with a minimum 1-year follow-up and to assess risk factors for recurrence.

METHODSFrom March 2002 to March 2010, 259 patients with recurrent anterior shoulder dislocation underwent arthroscopic Bankart repair with suture anchors. And 188 patients (50 athletes, 138 nonathletes) were available for follow-up. The mean age at the time of surgery was 25.3 years (range, 13 - 58 years). The mean follow-up was 38.6 months (range, 12 - 110 months). All of the 188 patients were evaluated preoperatively and postoperatively with the American Shoulder and Elbow Society (ASES) shoulder score and Rowe score system. The rate of recurrent instability, range of motion, and risk factors for postoperative recurrence were evaluated. The ASES score was 72.6 preoperatively, and Rowe score was 33.4.

RESULTSThe ASES scores improved significantly to 91.9 postoperatively (P < 0.001). The Rowe scores improved to 81.9 postoperatively (P < 0.001). And 152 patients were greatly satisfied with the results, 16 satisfied and 20 unsatisfied. The satisfactory rate was 89.4%. 24 patients (12.8%) suffered a recurrence after surgery, 14 athletes and 10 nonathletes. The recurrence rates were 28.0% in the athlete group and 7.2% in the nonathlete group. On average there was no significant loss of external rotation postoperatively (average, 75.2° preoperatively and 67.2° postoperatively). Patients under age 20, and athlete patients were associated with recurrence (P < 0.05). Other factors including length of time until surgery, type of anchors, number of anchors, presence of bony Bankart lesion, presence of a superior labrum, anterior and posterior tear, presence of posterior or inferior labrum lesion, presence of rotator cuff tear, ligamentous laxity and rotator interval closure did not influence the recurrence rate (P > 0.05).

CONCLUSIONSArthroscopic Bankart repair is a good option for the treatment of recurrent anterior shoulder dislocation. Identification of risk factors for recurrence allows for consideration of open stabilization. In the series, patients under age 20 and athlete patients are the most important risk factors for recurrence.

Adolescent ; Adult ; Arthroscopy ; Athletes ; Female ; Humans ; Joint Instability ; Male ; Middle Aged ; Range of Motion, Articular ; Recurrence ; Retrospective Studies ; Risk Factors ; Shoulder Dislocation ; pathology ; surgery ; Suture Anchors ; Treatment Outcome ; Young Adult

Adult ; Arthroscopy ; methods ; Female ; Humans ; Male ; Middle Aged ; Muscle, Skeletal ; surgery ; Shoulder Pain ; etiology ; surgery ; Tendons ; surgery ; Treatment Outcome

OBJECTIVETo compare open and arthroscopic methods for treatment of recalcitrant lateral epicondylitis.

METHODSA prospective trial of 26 patients (28 elbows) with recalcitrant lateral epicondylitis were treated between May 2006 and September 2008. The mean duration of conservative care was 23. 0 months (4 - 60 months). The mean follow-up was 17.4 months (4 - 32 months). The patients were randomized divided into two groups, 13 elbows with an open Nirschl procedure and 15 with an arthroscopic Nirschl procedure. All patients had pre- and post-operative assessment using VAS (visual analog scale) scores, Mayo 12 points elbow scores, time of return to work or sports, satisfaction, and so on.

RESULTSThere were no significant differences in VAS scores at rest and activities of daily living, time of return to work or sports and satisfaction between the two groups. But there was a statistically significant difference in VAS scores at work and sports and Mayo 12 points elbow scores between the two groups. 100% of the patients had excellent or good results in the open group and 93.3% in arthroscopic group. There were no severe complications in this series.

CONCLUSIONSBoth open and arthroscopic Nirschl procedures are valid and reliable treatments for patients with refractory lateral epicondylitis. The patients in the open group have a better function in the return-to work and sports postoperatively than the arthroscopic group.

Adult ; Arthroscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Orthopedic Procedures ; methods ; Prospective Studies ; Tennis Elbow ; surgery ; Treatment Outcome