Temporomandibular joint osteoarthritis (TMJ-OA) is a common disease often accompanied by pain, seriously affecting physical and mental health of patients. Abnormal innervation at the osteochondral junction has been considered as a predominant origin of arthralgia, while the specific mechanism mediating pain remains unclear. To investigate the underlying mechanism of TMJ-OA pain, an abnormal joint loading model was used to induce TMJ-OA pain. We found that during the development of TMJ-OA, the increased innervation of sympathetic nerve of subchondral bone precedes that of sensory nerves. Furthermore, these two types of nerves are spatially closely associated. Additionally, it was discovered that activation of sympathetic neural signals promotes osteoarthritic pain in mice, whereas blocking these signals effectively alleviates pain. In vitro experiments also confirmed that norepinephrine released by sympathetic neurons promotes the activation and axonal growth of sensory neurons. Moreover, we also discovered that through releasing norepinephrine, regional sympathetic nerves of subchondral bone were found to regulate growth and activation of local sensory nerves synergistically with other pain regulators. This study identified the role of regional sympathetic nerves in mediating pain in TMJ-OA. It sheds light on a new mechanism of abnormal innervation at the osteochondral junction and the regional crosstalk between peripheral nerves, providing a potential target for treating TMJ-OA pain.
Animals ; Osteoarthritis/physiopathology* ; Mice ; Sympathetic Nervous System/physiopathology* ; Temporomandibular Joint Disorders/physiopathology* ; Arthralgia ; Sensory Receptor Cells ; Disease Models, Animal ; Norepinephrine ; Male ; Temporomandibular Joint/physiopathology* ; Pain Measurement

Greater trochanteric pain syndrome(GTPS)is a disease caused by structural lesions of the muscles,fascia,ligaments,and bursae near the greater trochanter of the femur.GTPS causes lateral hip joint pain,severely affecting patients' quality of life.Ultrasound has many advantages,such as real-time diagnosis,portable operation,non-radiation,and high resolution,demonstrating a high application value in the diagnosis and interventional therapy of GTPS.This article reviews the current status of ultrasound in the diagnosis and interventional therapy of GTPS and prospects its application.
Humans ; Ultrasonography ; Femur/diagnostic imaging* ; Hip Joint/diagnostic imaging* ; Arthralgia/therapy*

OBJECTIVE: To investigate short-term effectiveness of arthroscopic repair via modified subacromial viewing portal (hereinafter referred to as modified viewing portal) in treatment of LafosseⅠsubscapularis tendon tears. METHODS: A clinical data of 52 patients with LafosseⅠsubscapularis tendon tears, who underwent the arthroscopic repair via modified viewing portal between October 2020 and November 2022 and met the selective criteria, was retrospectively analyzed. There were 15 males and 37 females with an average age of 63.4 years (range, 41-76 years). Twelve patients had trauma history and the other 40 patients had no obvious inducement. The main clinical symptom was shoulder pain and the hug resistance tests were positive in all patients. The interval between symptom onset and admission ranged from 3 to 26 months (mean, 7.2 months). The shoulder pain and function were evaluated by visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and University of California Los Angeles (UCLA) score before operation and at 12 months after operation. The shoulder range of motion (ROM) of forward flexion, abduction, and external rotation and the internal rotation strength were measured before operation and at 3 and 12 months after operation. MRI was performed at 3-6 months after operation to assess the tendon healing and the structural integrity and tension of reattached tendon. Patient's satisfactions were calculated at last follow-up. RESULTS: All incisions healed by first intention, no complication such as incision infection or nerve injury occurred. All patients were followed up 12-37 months (mean, 18.5 months). The VAS, UCLA, and ASES scores at 12 months after operation significantly improved when compared with those before operation ( P<0.05). The ROMs of abduction and forward flexion and the internal rotation strength at 3 and 12 months significantly improved when compared with those before operation ( P<0.05); and the ROMs at 12 months significantly improved compared to that at 3 months ( P<0.05). However, there was no significant difference ( P>0.05) in the ROM of external rotation at 3 months compared to that before operation; but the ROM at 12 months significantly improved compared to that before operation and at 3 months after operation ( P<0.05). Thirty-one patients underwent MRI at 3-6 months, of which 28 patients possessed intact structural integrity, good tendon tension and tendon healing; 3 patients underwent tendon re-tear. At last follow-up, 41 patients (78.8%) were very satisfied with the effectiveness, 7 were satisfied (13.5%), and 4 were dissatisfied (7.7%). CONCLUSION Arthroscopic repair via modified viewing portal for Lafosse Ⅰsubscapularis tendon tears, which can achieve the satisfactory visualization and working space, can obtain good short-term effectiveness with low overall re-tear risk.
Male ; Female ; Humans ; Middle Aged ; Rotator Cuff/surgery* ; Rotator Cuff Injuries/surgery* ; Shoulder Pain ; Retrospective Studies ; Treatment Outcome ; Arthroscopy ; Shoulder Joint/surgery* ; Tendons/surgery* ; Range of Motion, Articular

Introduction: Laparoscopic Cholecystectomy uses carbon dioxide (CO2) which affects the respiratory, cardiovascular and renal system. The residual CO2 induces phrenic nerve irritation, manifesting as shoulder and abdominal pain. Recruitment maneuvers opens the lungs and helps expelling this residual carbon dioxide. However, there are limited studies on its role to hemodynamics especially in patients undergoing abdominal laparoscopic procedures. Methods: Sixty patients (51 15.1) scheduled for laparoscopic cholecystectomy under General Endotracheal Anesthesia were randomly allocated to two groups. The control group (Group C) underwent standard laparoscopic cholecystectomy procedures. The experimental group (Group R) was placed in a Trendelenburg and was given 4-5 manual pulmonary inflations at a pressure of 40cmH20. The blood pressure, heart rate, respiratory rate and oxygen saturation, as well as the post operative site pain and shoulder pain were measured using the Numerical Pain Scale (NPS) were monitored at 0, 1 and 2 hours post operatively. Results: The demographics and preoperative vital signs were comparable. The mean systolic blood pressure [119.5 vs 131.5; p=0.002], mean arterial pressure [91.8 vs 95.3; p=0.049], heart rate [74.9 vs 87.5; p <0.001] and respiratory rate [15.7 vs 16.2; p=0.02] were all differrent only during the immediate post operative period. The mean shoulder pain was lower in Group R immediately [1.9 ± 1.2; p=0.01] and 1 hour after surgery [0.7 ± 0.8; p=0.01]. Conclusion Recruitment maneuver significantly reduces the shoulder pain scores after laparoscopic cholecystectomy. It causes a decrease in blood pressure, heart rate and mean arterial pressure in the immediate post operative period.
Cholecystectomy, Laparoscopic ; Shoulder Pain ; Hemodynamics ; Carbon Dioxide

OBJECTIVE: To observe the clinical efficacy on hemiplegic shoulder pain (HSP) after stroke treated with electroacupuncture (EA) under different frequencies. METHODS: A total of 105 patients with HSP after stroke were randomly divided into a manual acupuncture group (35 cases, 2 cases dropped off), an EA continuous wave group (35 cases, 3 cases dropped off) and an EA disperse-dense wave group (35 cases). The conventional rehabilitation therapy was delivered in the three groups. Additionally, acupuncture was applied to Jianyu (LI 15), Jianzhen (SI 9), Jianliao (TE 14) and Jianqian (Extra) etc. on the affected side in the manual acupuncture group. In the EA continuous wave group and the EA disperse-dense wave group, besides the treatment as the manual acupuncture group, the electric stimulation was attached to two pairs of acupoints, i.e. Jianyu (LI 15) and Jianliao (TE 14), and Quchi (LI 11) and Shousanli (LI 10), with 15 Hz continuous wave, and 2 Hz/ 100 Hz disperse-dense wave, respectively. The treatment was given once daily, 5 times a week, for 4 weeks consecutively. The score of visual analogue scale (VAS) before treatment and after 2 and 4 weeks of treatment, as well as the passive range of motion (PROM) of shoulder forward flexion and PROM of shoulder abduction, muscle strength of the upper limb, the score of modified Barthel index (MBI) and the score of Fugl-Meyer assessment (FMA) before and after treatment were observed in each group. RESULTS: Compared with before treatment, VAS scores were reduced after 2 and 4 weeks of treatment in each group (P<0.05); and VAS scores after 4 weeks of treatment were lower than those after 2 weeks of treatment (P<0.05). After 2 and 4 weeks of treatment, VAS score in either the EA continuous wave group or the EA disperse-dense wave group was lower compared with the manual acupuncture group (P<0.05). After 4 weeks of treatment, VAS score in the EA disperse-dense wave was lower than that of the EA continuous wave group (P<0.05). Compared with before treatment, PROM of the shoulder forward flexion and abduction on the affected side after treatment was enlarged (P<0.05), the muscle strength of the upper limb was increased (P<0.05), and the scores of MBI and FMA were increased (P<0.05) in the patients of each group. After treatment, in the EA continuous wave group and the EA disperse-dense wave group, PROM of the shoulder forward flexion on the affected side was higher (P<0.05), the muscle strength of the upper limb was stronger (P<0.05) when compared with the manual acupuncture group; and the scores of MBI and FMA in the EA disperse-dense wave group were higher than those of the manual acupuncture group (P<0.05). CONCLUSION Electroacupuncture is superior to manual acupuncture in the analgesic effect and comprehensive rehabilitation effect in the patients with HSP after stroke. The therapeutic effect obtained by electroacupuncture with 2 Hz/100 Hz disperse-dense wave is better than that with 15 Hz continuous wave.
Humans ; Electroacupuncture ; Shoulder Pain/therapy* ; Hemiplegia/therapy* ; Stroke/complications* ; Acupuncture Therapy ; Treatment Outcome ; Acupuncture Points

OBJECTIVE: To compare the clinical effect of conventional acupuncture combined with pricking and cupping at Jianbo area and conventional acupuncture in the treatment of scapulohumeral periarthritis of frozen stage. METHODS: A total of 66 patients with scapulohumeral periarthritis of frozen stage were randomly divided into a combination group (31 cases) and an acupuncture group (35 cases, 1 case dropped off). Both groups were given functional exercise. Patients in the acupuncture group were treated with acupuncture at Jianyu (LI 15), Jianliao (TE 14), Binao (LI 14) and ashi point on the affected side, once every other day, three times a week, for a total of 4 weeks. On the basis of treatment in the acupuncture group, the patients in the combination group were treated with pricking and cupping at Jianbo area (the area surrounded by the 3 acupoints of Tianzong [SI 11], Naoshu [SI 10] and Jianzhen [SI 9]), once a week for 4 weeks. The University of California-Los Angeles (UCLA) shoulder joint score, visual analogue scale (VAS) score before treatment, after treatment and after 6 months of treatment completion (follow-up) and tenderness threshold before and after treatment, and the clinical effects of the two groups after treatment and in follow-up were evaluated. RESULTS: In the two groups, after treatment and in follow-up, the UCLA shoulder joint scores were higher than those before treatment (P<0.05), and the VAS scores were lower than those before treatment (P<0.05). In the combination group, after treatment and in follow-up, the UCLA shoulder joint score was higher than that of the acupuncture group (P<0.05), and the VAS score was lower than that of the acupuncture group (P<0.05). After treatment, the tenderness thresholds of the two groups were higher than those before treatment (P<0.05), and the tenderness threshold in the combination group was higher than that in the acupuncture group (P<0.05). After treatment and in follow-up, the cured and markedly effective rate of the combination group was 48.4% (15/31) and 51.6% (16/31) respectively, which was higher than 23.5% (8/34) and 23.5% (8/34) of the acupuncture group (P<0.05). CONCLUSION Pricking and cupping in Jianbo area combined with conventional acupuncture can improve shoulder joint function and relieve shoulder joint pain in patients with scapulohumeral periarthritis of frozen stage, and the curative effect is better than that of single conventional acupuncture.
Humans ; Periarthritis/therapy* ; Acupuncture Therapy ; Shoulder Pain/therapy* ; Shoulder Joint ; Acupuncture Points ; Treatment Outcome

OBJECTIVES: To observe the effects of acupoint application with turmeric blistering moxibustion plaster on pain, shoulder range of motion (ROM) and upper limb motor function in the patients with post-stroke hemiplegic shoulder pain (PSHSP). METHODS: Eighty-two patients with PSHSP were randomly divided into an observation group (41 cases, 1 case was eliminated, 4 cases dropped out) and a control group (41 cases, 2 cases were eliminated and 2 cases dropped out). The routine treatment, nursing care and rehabilitation training were performed in the control group. On the basis of the intervention as the control group, in the observation group, the turmeric blistering moxibustion plaster was applied to bilateral ashi points, Jianyu (LI 15), Jianliao (TE 14), Binao (LI 14), Shousanli (LI 10) and Hegu (LI 4), once a day, remained for 6 hours each time. This moxibustion therapy was operated 5 times weekly, one course of treatment consisted of 2 weeks and 2 courses were required. Separately, before treatment and after 2 and 4 weeks of treatment, the score of visual analogue scale (VAS), shoulder ROM and the score of upper limbs in Fugl-Meyer assessment (U-FMA) were observed in the two groups. RESULTS: VAS scores were lower (P<0.05), ROM in shoulder flexion, abduction, internal rotation and external rotation was larger (P<0.05), and U-FMA scores were higher (P<0.05) after 2 and 4 weeks of treatment when compared with those before treatment in the two groups. After 4 weeks of treatment, VAS score decreased (P<0.05), and ROM in shoulder flexion, abduction, internal rotation, external rotation and U-FMA score increased (P<0.05) in comparison with those after 2 weeks of treatment in either group. In the observation group, VAS scores were dropped (P<0.05) after 2 and 4 weeks of treatment respectively, and ROM of shoulder flexion and abduction enlarged after 2 weeks of treatment (P<0.05) when compared with those in the control group. After 4 weeks of treatment, ROM in shoulder flexion, abduction, internal rotation and external rotation in the observation group was larger (P<0.05) and U-FMA score was higher (P<0.05) than those in the control group. CONCLUSIONS Acupoint application with turmeric blistering moxibustion plaster may effectively reduce the degree of shoulder pain and improve the shoulder range of motion and the upper limb motor function in the patients with post-stroke hemiplegic shoulder pain.
Humans ; Shoulder ; Moxibustion ; Shoulder Pain/therapy* ; Acupuncture Points ; Curcuma ; Hemiplegia/therapy* ; Treatment Outcome

OBJECTIVES: To observe the clinical efficacy of moxibustion as an adjunctive treatment for rheumatoid arthritis (RA) based on conventional medication and its effects on serum sclerostin (SOST) and β-catenin levels, exploring the potential mechanisms by which moxibustion may protect joint bones in RA patients. METHODS: Seventy-six RA patients were randomly divided into an observation group (38 cases, 3 cases dropped out) and a control group (38 cases, 4 cases were eliminated, 2 cases dropped out). The patients in the control group were treated with conventional oral medication; based on the treatment of the control group, the patients in the observation group were treated with moxibustion. The direct moxibustion was applied at Zusanli (ST 36) on both sides and ashi points around small joints, and indirect moxibustion was applied at Shenshu (BL 23) on both sides and ashi points around large joints. The treatment was given three times a week for a total of 5 weeks. The count of pain and swollen joint, morning stiffness score, disease activity score of 28 joints (DAS28), visual analogue scale (VAS) score, health assessment questionnaire (HAQ) score, and serum levels of SOST, β-catenin, and tumor necrosis factor-α (TNF-α) were evaluated before and after treatment in the two groups. RESULTS: Compared those before treatment, after treatment, both groups showed a reduction in pain and swollen joint count (P<0.01, P<0.05), morning stiffness, DAS28, VAS, and HAQ scores (P<0.01, P<0.05), with the observation group having lower scores than the control group (P<0.01). Serum levels of SOST, β-catenin, and TNF-α after treatment in the observation group were lower than those in both before treatment and the control group (P<0.01, P<0.05). There was a positive correlation between the difference in serum β-catenin levels before and after treatment and the difference in serum SOST (r=0.578, P<0.001) and TNF-α (r=0.403, P<0.05) levels in the observation group. CONCLUSIONS In addition to medication, moxibustion as an adjunctive treatment could significantly alleviate joint pain and reduce disease activity in RA patients, suggesting a potential role in joint protection. This mechanism may be related to the inhibition of the inflammatory factor TNF-α, regulation of β-catenin levels, and reduction in the production of the endogenous negative regulator protein SOST within the Wnt/β-catenin signaling pathway.
Humans ; Moxibustion ; Tumor Necrosis Factor-alpha ; beta Catenin ; Acupuncture Points ; Arthritis, Rheumatoid/therapy* ; Arthralgia ; Adaptor Proteins, Signal Transducing

OBJECTIVE: To explore clinical features, treatment methods and clinical effects of cervical spondylosis with proximal muscular atrophy. METHODS: Eleven patients with proximal-type cervical spondylotic amyotrophy were retrospectively studied from September 2016 to November 2020, including 7 males and 4 females, aged 38 to 68 years old. Clinical symptoms, MRI and neuroelectrophysiological manifestations were analyzed, and patients were treated with conservative treatment or anterior cervical decompression fusion surgery, respectively. The efficacy was evaluated by manual muscle test (MMT) before and after treatment, and patients' satisfaction was followed up at the same time. RESULTS: All patients were followed up for 6 to 19 months. All 11 patients were unilateral, mainly manifested by atrophy of deltoid muscle, supraspinatus muscle and infraspinatus muscle, and may be accompanied by ipsilateral neck and shoulder pain at early stage. MRI showed lesions at C_4,5, C_5,6 segments were more common. Electrophysiological examination showed the affected muscle was denervated, and amplitude of compound muscle action potential (CMAP) of innervated nerve on the affected side was lower than that on the healthy side. All patients were obtained bone fusion. One patient who were underwent anterior cervical corpectomy and fusion (ACCF) occurred developed contralateral C5 nerve root paralysis after operation, which recovered completely after 10 weeks of symptomatic treatment. At 12 months after operation, the efficacy was evaluated according to MMT, 3 patients were treated conservatively, 2 patients excellent and 1 good;in 8 patients treated by operation, 3 patients were excellent, 4 good, and 1 moderate. CONCLUSION The incidence of cervical spondylosis with proximal muscular atrophy is low, which is manifested as unilateral proximal muscle atrophy and may be accompanied by ipsilateral neck and shoulder pain in the early stage. Combined with MRI and neuroelectrophysiological examination, misdiagnosis could be reduced. In the early stage of disease, especially in the case of nucleus pulposus protrusion leading to nerve compression, conservative treatment could be taken. When the conservative treatment is ineffective or the pain cannot be tolerated, anterior decompression surgery is recommended, and the overall effect is satisfactory.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Retrospective Studies ; Shoulder Pain ; Cervical Vertebrae/pathology* ; Muscular Atrophy/surgery* ; Decompression, Surgical/methods* ; Spondylosis/surgery* ; Treatment Outcome ; Spinal Fusion/adverse effects*

OBJECTIVE: To systematically evaluate obesity on the outcome of rotator cuff repair. METHODS: Literatures on the relationship between obesity and outcomes after rotator cuff repair were searched from PubMed, Embase, Cochrane Library, Web of Science, China biology medicine(CBM), CNKI, Wanfang and VIP databases from building database to August 1, 2022, and were screened independently by two authors according to inclusion and exclusion criteria. Endnote X9 and Excel 2019 were used for literature extraction, management and data entry, and Newcastle-Ottawa Scale (NOS) was used to evaluate quality of the included literatures. STATA 16.0 and RevMan 5.4 softwares were used to evaluate postoperative retear rate, reoperation rate, complication rate, American Shoulder and Elbow Surgeons (ASES) score, visual analogue scale (VAS), operative time and external rotation angle of shoulder joint pain were analyzed. RESULTS: Totally 13 literatures were included, including 6 retrospective studies, 5 case-control studies, 1 prospective cohort study, and 1 abstract of a study for which the full text was not available, with 85 503 patients (31 973 in obese group and 53 530 in non-obese group). Meta-analysis showed there were statistical differences between two groups in retear rate [OR=2.58, 95%CI(1.23, 5.41), P=0.01], reoperation rate[OR=1.31, 95%CI(1.21, 1.42), P<0.00], complication rate [OR=1.57, 95%CI(1.31, 1.87), P=0.00], ASES score[MD=-3.59, 95%CI(-5.45, -1.74), P=0.00], and VAS[MD=0.24, 95%CI(0.00, 0.49), P=0.05]. While there were no differences between two groups in operative time[MD=6.03, 95%CI(-7.63, 19.69), P=0.39], external rotation angle of shoulder joint[MD=-1.79, 95%CI(-5.30, 1.71), P=0.32]. CONCLUSION Obesity is associated with higher rates of retear, resurgery, complications, poorer shoulder function and pain after rotator cuff repair.
Humans ; Rotator Cuff/surgery* ; Rotator Cuff Injuries/complications* ; Retrospective Studies ; Prospective Studies ; Treatment Outcome ; Shoulder Pain ; Obesity/surgery* ; Arthroscopy