Humeral retroversion, shoulder range of motion, and functional mobility in striking martial arts athletes.

The aim of the study was to evaluate humeral retroversion, shoulder range of motion, and functional mobility in karatekas, boxers, kickboxers, and mixed martial arts fighters. This study investigated adaptive alterations in striking martial arts. Forty young healthy participants took part in the study. 20 people who professionally trained in boxing, kickboxing, karate, and Mixed Martial Arts (MMA) fighters (age: 23.5 ± 7.1, age of participation 11.8 ± 3.65, sports experience 9.55 ± 5.13, body weight 79.2 ± 13 kg, BMI 24.4 ± 3.3) were qualified for the group of athletes. 20 people (age: 27 ± 5.5, body weight 79.4 ± 7.4, BMI 24.5 ± 1.2) were included in the control group, who had no previous experience with striking combat sports. An ultrasound device and a digital inclinometer were used for the examination of the humeral retroversion angle. The mobility of the shoulder was also tested using the Functional Movement Screen (FMS). There was a significant (p < 0.001, r = 0.92) asymmetry between the dominant and non-dominant limb in the humeral retroversion angle in the athlete group. A statistically significant moderate correlation (p < 0.05) was found between the value of the retroversion angle and the range of motion of passive and active internal rotation, and external rotation, and the shoulder mobility in the FMS test. However, there were no statistically significant differences (p > 0.05) in the humeral retroversion angles between groups. The striking martial arts athletes do not exhibit significant differences in humeral retroversion compared to non-athletes, however they display notable asymmetry between limbs, with higher values in the non-dominant arm. Additionally, the observed correlation between humeral retroversion and shoulder rotation range of motion highlights the potential impact of humeral retroversion on upper limb performance and injury risk.

Kinematic differences in forehand serve-receiving techniques of the male tennis players at low and high-speed serves.

The purpose of this study was to compare the joint, racket, and ball kinematics between the different levels of male tennis players in tennis serve-return at slow and high serve speeds. Thirty male tennis players were divided into an advanced group (n = 15) and an intermediate group (n = 15) based on skill level. The advanced group and intermediate group matched shake hand-grip players performed serve-receive test at the different serve speeds. Kinematic data were collected on the trunk, upper limbs, racket and ball to compare the differences between the advanced and intermediate groups at different serve speeds. At both serve speeds, the AG has faster racket speed and ball speed, and is closer to the baseline placement (p<0.05). It is characterized by a faster trunk turn, greater speed with the shoulder joint forward and outward and greater angle of wrist flexion and extension during the stroke (p<0.05), and greater speed with the forearm inward and internal rotation during the follow-through swing, at the same time, there is a difference in the angle of the racket to the ground between the advanced group and an intermediate group(p<0.05). Elbow internal rotation and abduction angular velocity in the backswing phase, Timing of peak racket resultant velocity and Wrist extension in the stroke phase, and shoulder and elbow joint activities in the follow-through phase were significantly correlated with the ball speed of the return. With faster serve speeds, higher quality serve-receive can be achieved by shortening the duration of the backswing lifting the upper arm and rotating the forearm inward quickly, accelerating the speed of movement of wrist joints at the impact phase, adjusting the speed of shoulder adduction and elbow internal rotation to complete the follow-through swing. These findings help to improve elite players' serve-receive skills at faster serve speed.

Role of joint interactions in upper limb joint movements: a disability simulation study using wearable inertial sensors for 3D motion capture.

BACKGROUND: Restriction of movement at a joint due to disease or dysfunction can alter the range of motion (ROM) at other joints due to joint interactions. In this paper, we quantify the extent to which joint restrictions impact upper limb joint movements by conducting a disability simulation study that used wearable inertial sensors for three-dimensional (3D) motion capture. METHODS: We employed the Wearable Inertial Sensors for Exergames (WISE) system for assessing the ROM at the shoulder (flexion-extension, abduction-adduction, and internal-external rotation), elbow (flexion-extension), and forearm (pronation-supination). We recruited 20 healthy individuals to first perform instructed shoulder, elbow, and forearm movements without any external restrictions, and then perform the same movements with restriction braces placed to limit movement at the shoulder, elbow, and forearm, separately, to simulate disability. To quantify the extent to which a restriction at a non-instructed joint affected movement at an instructed joint, we computed average percentage reduction in ROM in the restricted versus unrestricted conditions. Moreover, we performed analysis of variance and post hoc Tukey tests (q statistic) to determine the statistical significance (p < 0.05 denoted using *) of the differences in ROM of an instructed joint in the unrestricted versus restricted conditions. RESULTS: Restricting movement at the shoulder led to a large reduction in the average ROM for elbow flexion-extension (21.93%, q = 9.34*) and restricting elbow movement significantly reduced the average ROM for shoulder flexion-extension (17.77%, q = 8.05*), shoulder abduction-adduction (19.80%, q = 7.60*), and forearm pronation-supination (14.04%, q = 4.96*). Finally, restricting the forearm significantly reduced the average ROM for shoulder internal-external rotation (16.71%, q = 3.81*) and elbow flexion-extension (10.01%, q = 4.27*). CONCLUSIONS: Joint interactions across non-instructed joints can reduce the ROM of instructed movements. Assessment of ROM in the real-world using 3D motion capture, for example using the WISE system, can aid in understanding movement limitations, informing interventions, and monitoring progress with rehabilitation.

3-Dimensional (3D) Isotropic MRI of the Shoulder - Advantages Over 2D MRI.

The increasing implementation of high-field MRI scanners and the development of novel imaging techniques have rendered 3D imaging of joints more feasible and efficient than ever. This article describes the current state of 3D MRI of the shoulder and highlights the benefits of the technique over conventional 2D MRI with respect to shoulder derangements.

Kinematic characterization of backhand stroke accuracy in squash based on kinematic variables between two different skill levels-a preliminary cross-sectional study.

Background: The aim of this study was to compare differences in shot placement and accuracy between national and international level squash players. Squash is a technically demanding sport and understanding the biomechanical characteristics of athletes at different levels is important for developing effective training strategies. Methods: The study used a three-dimensional motion analysis system, a high-speed video camera, and a professional tee for biomechanical testing. Participants included national and international level squash players. The kinematic characteristics of the shoulder, elbow, and wrist joints of the upper extremity for backhand strokes, as well as the accuracy of the strokes, were analyzed to compare the differences between the two groups of athletes in terms of stroke posture and accuracy. Results: The kinematic analysis of the backward backhand stroke revealed that national squash players showed significant differences compared to international players in several key parameters. Specifically, national players had significantly greater trunk flexion (P = 0.018) and less shoulder medial rotation (P = 0.027). They also had lower racket velocity in the X-direction (P = 0.043). However, there were no significant differences in trunk lateral flexion (P = 0.487), trunk rotation (P = 0.293), shoulder extension/flexion (P = 0.396), elbow flexion/extension (P = 0.818), wrist flexion/extension (P = 0.177), wrist rotation (P = 0.476), racket pitch (P = 0.112), racket velocity in the Y-direction (P = 0.587), or racket velocity in the Z-direction (P = 0.327). Additionally, data for racket yaw, racket roll, and racket Vx were not provided with significant values, indicating that these parameters do not show significant differences. Conclusion: International level players outperformed national level players in squash stroke accuracy and control. Key kinematic factors influencing accuracy include trunk forward flexion, shoulder abduction, shoulder internal rotation, and racket angles. The study recommends that coaches design training to enhance technical details and positional control to improve squash performance.

Alkaptonuric Ochronosis: A case-based review.

Alkaptonuria (AKU) is an extremely rare autosomal recessive metabolic disorder caused by deficiency of homogentisic acid oxidase and resulting in accumulation of homogentisic acid in collagenous structures. It is characterized by a triad of homogentisic aciduria, bluish-black discoloration of connective tissues (ochronosis) and arthropathy of large weight bearing joints. We report on a middle-aged female patient with bilateral severe ochronotic arthritis of both hips and shoulder joints requiring total joint replacements as staged procedures which were done without complications offering a complete pain relief and a satisfactory clinical and functional outcome. Ochronosis can cause severe arthropathy of peripheral joints. Multiple joint affection is common. Total joint replacement can yield persistent pain relief with complete functional recovery in patients with severe ochronotic arthropathy.

Joint position and force senses in young female tennis players and untrained adolescents.

The aim of the study was to determine the differences between tennis players and untrained peers in the development of upper limb proprioception in 10-15-year-olds. A group of 67 girls (12.75 ± 1.46 years old), including 33 tennis players and 34 age-matched untrained controls, was divided into three age groups: A1, 10-11-years-old; A2, 12-13-years-old; and A3, 14-15-years-old. Joint position sense (JPS) and force sense (FS) were assessed by reproducing memorized target angle or torque value of three joints: glenohumeral, elbow, and radiocarpal. The JPS error for the elbow joint in group A1 was 71% and 80% higher (p < 0.01) than that in groups A2 and A3, respectively, and the performance of all tennis players was 27.5% (p = 0.01) better than that of untrained controls. For FS, proprioception of only the more demanding task tested (reproduction of 50% maximal voluntary contraction) and specific function (elbow and radiocarpal extension, and glenohumeral internal rotation) showed development with age. The error values for elbow extension (A1, A2) and the glenohumeral joint (A3) of tennis players were lower than those of age-matched controls. We conclude that the development of FS in the upper limb varied and was related to the specific functions and joints. The 10-13-year-old tennis players showed elbow extensor FS performance at the level of the older participants, while the 14-15-year-old tennis players were characterized with superior FS internal rotation performance in the glenohumeral joint.

Handrim Reaction Force and Moment Assessment Using a Minimal IMU Configuration and Non-Linear Modeling Approach during Manual Wheelchair Propulsion.

Manual wheelchair propulsion represents a repetitive and constraining task, which leads mainly to the development of joint injury in spinal cord-injured people. One of the main reasons is the load sustained by the shoulder joint during the propulsion cycle. Moreover, the load at the shoulder joint is highly correlated with the force and moment acting at the handrim level. The main objective of this study is related to the estimation of handrim reactions forces and moments during wheelchair propulsion using only a single inertial measurement unit per hand. Two approaches are proposed here: Firstly, a method of identification of a non-linear transfer function based on the Hammerstein-Wiener (HW) modeling approach was used. The latter represents a typical multi-input single output in a system engineering modeling approach. Secondly, a specific variant of recurrent neural network called BiLSTM is proposed to predict the time-series data of force and moments at the handrim level. Eleven subjects participated in this study in a linear propulsion protocol, while the forces and moments were measured by a dynamic platform. The two input signals were the linear acceleration as well the angular velocity of the wrist joint. The horizontal, vertical and sagittal moments were estimated by the two approaches. The mean average error (MAE) shows a value of 6.10 N and 4.30 N for the horizontal force for BiLSTM and HW, respectively. The results for the vertical direction show a MAE of 5.91 N and 7.59 N for BiLSTM and HW, respectively. Finally, the MAE for the sagittal moment varies from 0.96 Nm (BiLSTM) to 1.09 Nm for the HW model. The approaches seem similar with respect to the MAE and can be considered accurate knowing that the order of magnitude of the uncertainties of the dynamic platform was reported to be 2.2 N for the horizontal and vertical forces and 2.24 Nm for the sagittal moments. However, it should be noted that HW necessitates the knowledge of the average force and patterns of each subject, whereas the BiLSTM method do not involve the average patterns, which shows its superiority for time-series data prediction. The results provided in this study show the possibility of measuring dynamic forces acting at the handrim level during wheelchair manual propulsion in ecological environments.

A retrospective comparative study on the effectiveness of multisite injection versus arthroscopic capsular release for idiopathic frozen shoulder.

Arthroscopic capsular release is a most well-known technique with favorable outcomes for frozen shoulder. However, considering the surgical trauma and the improvement of multisite injection, we design a study to compare the pain relief and safety of multisite injection (MI) versus arthroscopic capsular release (ACR) for frozen shoulder. A total of 80 patients with unilater al frozen shoulder were enrolled in this study. Group RBT (n = 40) received multisite injection (0.5% lidocaine and triamcinolone acetonide, once a week, no more than 2 injections), while Group ACR received arthroscopic capsular release. The following parameters were employed to compare: visual analog scale (VAS), range of motion (ROM), the Disability of Arm, Hand, and Shoulder (DASH) score and Oxford shoulder score (OSS). Side effects were also recorded. The VAS, ROM, DASH and OSS all improved significantly (P < 0.001). Internal rotation and external rotation at 1 month after operation were better in ACR group (40.35 ± 4.79 Vs 36.58 ± 7.49, 40.55 ± 4.37 Vs 38.63 ± 4.01, P = 0.009,0.043). However, no significance in terms of functional results and ROM was found at 6 months after operation. The OSS, DASH and VAS in patients with diabetes were 44.25 ± 3.05, 2.29 ± 1.12 and 0.50 ± 0.72, compared with 43.89 ± 3.09, 2.34 ± 1.49 and 0.29 ± 0.56 in patients without diabetes (P = 0.636, 0.889, 0.157). Multisite injection and arthroscopic capsular release are both effective treatments in the treatment of frozen shoulder. However, multisite injection is a simple, cost effective and superior alternative.

Patients With Graft Tears Leaving the Tuberosity Covered Have Similar Functional Outcomes to Those With an Intact Graft After Superior Capsular Reconstruction.

BACKGROUND: Studies to date of superior capsular reconstruction (SCR) comparing outcomes of healed grafts versus torn grafts do not separate graft tears based on location of the tear, rather they combine and report all tears as a single group. PURPOSE/HYPOTHESIS: The purpose of this study was to correlate functional outcome with graft integrity and graft tear location after SCR with a dermal allograft. It was hypothesized that the functional outcomes of patients with an intact graft would be equivalent to those with graft tears leaving the tuberosity covered. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients who underwent SCR with an acellular dermal allograft at a single institution were included. Pre- and postoperative American Shoulder and Elbow Surgeons (ASES), Oxford Shoulder Score, visual analog scale (VAS) for pain, and postoperative Single Assessment Numeric Evaluation (SANE) scores were recorded. A magnetic resonance imaging scan was performed postoperatively to assess graft integrity. RESULTS: A total of 39 patients met inclusion criteria. Mean age of patients was 60.4 ± 8.7 years; mean follow-up was 53.3 ± 25 months (range, 14-98 months). Magnetic resonance imaging performed at a mean of 17.5 months (range, 6-66 months) demonstrated an intact graft in 14 (36%); tear from the glenoid in 11 (28%), from midsubstance in 4 (10%), and from the tuberosity in 8 (21%); and complete graft absence in 2 (5%). Patients were divided into group 1 (intact graft), group 2 (tuberosity covered: tears from glenoid and midsubstance tears), and group 3 (tuberosity bare: tears from the tuberosity and dissolved or absent grafts). In group 1, there was significant improvement in ASES (37.9 to 88.5; P < .001), Oxford (25.2 to 46.2; P < .001), and VAS (6.8 to 0.9; P < .001). In group 2, there was significant improvement in ASES (32.2 to 86.1; P < .001), Oxford (23.4 to 44.2; P < .001), and VAS (7.3 to 1.3; P < .001). In group 3, there was no significant improvement in ASES (40.3 to 45.8; P = .50) or Oxford (33.5 to 31.4; P = .81), but there was a significant reduction in VAS (7.1 to 5.4; P = .03). There was no significant difference between group 1 and 2 in postoperative ASES (88.5 vs 86.1; P = .59), Oxford (46.2 vs 44.2; P = .07), VAS (0.9 vs 1.3, P = .42) and SANE (85.4 vs 83.2; P = .92) scores. However, group 3 had significantly lower ASES (45.8; P < .001), lower Oxford (31.4; P < .001), lower SANE (45.4; P < .001), and higher VAS (5.4; P < .001) scores than groups 1 and 2. There were no differences in outcomes based on sex (P = .72), previous surgery (P = .06), preoperative acromiohumeral distance (P = .57), and preoperative Goutallier stage of the supraspinatus (P = .16). CONCLUSION: Patients who underwent SCR with a dermal allograft and developed a graft tear leaving the tuberosity covered had equivalent functional outcomes to those with an intact graft.

Enhancing medical education for undergraduates: integrating virtual reality and case-based learning for shoulder joint.

BACKGROUND: The integration of Virtual Reality (VR) with Case-Based Learning (CBL) has the potential to revolutionise undergraduate medical education, particularly in complex subjects such as the anatomy and rehabilitation of the shoulder joint. This study aimed to explore the effectiveness of this innovative approach in enhancing learning outcomes and knowledge retention. METHODS: This study employed a parallel-group, assessor-blinded randomised controlled trial (RCT) design. A comprehensive five-week educational programme was developed, combining traditional lecture-based learning with VR-enhanced CBL. The study involved 82 undergraduate students from China Medical University, who were divided into groups receiving different combinations of VR and CBL. Student performance was evaluated through tests and questionnaires. RESULTS: In the anatomy-related courses, the integration of VR technology with CBL yielded significantly higher results (87.71 ± 5.60) compared to traditional methods (82.59 ± 6.64), with a statistically significant difference (P < 0.05). This provides compelling evidence of VR's potential to enhance student engagement and knowledge retention. In the context of physiotherapy-related courses, however, while the test scores of the VR-combined CBL group (81.85 ± 5.99) were marginally higher than those of the traditional CBL group (79.02 ± 7.57), this difference was not statistically significant (P > 0.05). CONCLUSION: The present study provides preliminary evidence for the benefits of incorporating VR into medical education, particularly in anatomy. While the results are promising, further research is needed to explore the optimal integration of VR and CBL in rehabilitation studies and to assess their long-term impact on student learning and clinical performance. TRIAL REGISTRATION: The study was registered with Chinese Clinical Trials Registry (Registration Number: ChiCTR2400089295) on 05/09/2024.

Arthroscopic shoulder surgery for gouty long head of biceps tendinitis: a case report.

OBJECTIVE: The objective of the case report is to analyze the clinical manifestations and imaging features of gouty long head of biceps tendinitis, and to summarize the methods and effects of shoulder arthroscopic surgery. CLINICAL PRESENTATION AND INTERVENTION: The clinical data of a 39-year-old Han Chinese female with gouty long head of the biceps tendinitis was retrospectively analyzed, and the clinical manifestations, imaging features, and diagnosis and treatment were analyzed. The patient presented with pain and limited movement of right shoulder joint. Computed tomography showed irregular high-density shadows above the glenoid and adjacent to the coracoid process of the right shoulder. Magnetic resonance imaging revealed superior labrum anterior and posterior injury with edema in the upper recess and axillary sac. After arthroscopic surgery, the "tofu residue" tissue of the long head of the biceps was removed, and the postoperative pathological examination proved that it was gout stone. CONCLUSION: Gouty long head of the biceps tendinitis is a rare disease. Arthroscopic surgery can probe the structural lesions of shoulder cavity in all aspects, improve the surgical accuracy, and reduce the trauma.

[Research progress on factors of shoulder stiffness after rotator cuff tear repair].

Rotator cuff tear is a common shoulder injury in daily work and sports activities. Arthroscopic repair is the most widely used method for rotator cuff tears, and the postoperative prognosis is good. However, there are still a series of postoperative complications that affect the therapeutic effect and patient satisfaction, such as postoperative pain, infection, retear, shoulder stiffness, etc. This paper reviews the occurrence and influencing factors of shoulder stiffness after arthroscopic repair of rotator cuff tear, in order to provide reference for the prevention of postoperative shoulder stiffness and explore the mechanism of postoperative shoulder stiffness.

Systematic Review of Arthroscopic Bankart Repair Outcomes for Anterior Shoulder Instability.

BACKGROUND The shoulder is a complex joint that has the most extensive range of motion among all joints, resulting in more susceptibility to dislocation. The treatment for acute shoulder dislocation is closed reduction, which should be performed immediately. Arthroscopic Bankart repair (ABR) is a procedure for treating anterior shoulder instability. This systematic review aimed to evaluate the published literature on ABR for anterior shoulder instability. MATERIAL AND METHODS We searched electronic databases, including Google Scholar, PubMed, Science Direct, Scopus, and PubMed, to find literature about our topic published between 2018 and 2023. Different keywords were searched, including "ABR, shoulder, instability, dislocation, treatment, management, recurrence, outcomes, and complications". The inclusion criteria were English original articles with available full text. RESULTS Only 8 articles were included; the articles included a total of 398 patients with an age range of 15 to 55 years old. One study was conducted on male patients, and another was conducted on female patients, whereas the remaining studies were conducted on both sexes. Among the 8 studies, 4 studies conducted ABR alone, and all reported significant change with ABR. Four studies compared ABR with Latarjet, concomitant remplissage, and immobilization and reported that ABR is equivalent or better than these interventions. CONCLUSIONS ABR was effective in the management of shoulder instability, as it resulted in a lower rate of recurrence, low rate of complications, and high rate of return to sport, regardless of the suture type. However, it is superior or similar to other interventions, like Latarjet and concomitant remplissage.

Controversies in surgical management of anterior shoulder instability. State of the Art.

Arthroscopic Bankart repair (ABR) has been accepted as a standard procedure for anterior shoulder instability with a minimum or no glenoid bone loss and an on-track Hill-Sachs lesion if present. However, several controversies exist in the surgical treatment of anterior shoulder instability. This article will discuss some of these controversies in, "simple," dislocations (without bone loss) as well as, "complex," (with critical bone loss). Determining which patients will benefit from an arthroscopic procedure depends on multiple factors including age, activity level, adequate determination of bone loss, performed with feasible and reliable imaging techniques. In the absence of concomitant significant bony and soft tissue pathology, ABR alone can provide satisfactory clinical results on a long-term basis. Controversies, including whether to remove cartilage from the edge of the glenoid, knotted versus knotless anchors, and routine rotator interval closure, still exist. In cases with significant bone loss, several bone restoring procedures have been described, such as, the Latarjet procedure, iliac crest bone graft, arthroscopic anatomic glenoid reconstruction with a frozen distal tibial allograft, and fresh distal tibial allograft reconstruction. This article will address these controversies and provide guidance based on available published data.

Tranexamic Acid in Shoulder and Knee Arthroscopy.

The role of tranexamic acid (TXA) in orthopaedic surgery is expanding. It has been shown to decreased blood loss in orthopaedic trauma, total joint arthroplasty, and spine surgery. Although significant blood loss with arthroscopic surgery is rare, the use of TXA in these procedures has been advocated to help with intraoperative visualization and decreased postoperative swelling and hemarthrosis. TXA in shoulder arthroscopy may improve visual clarity, decrease the amount of fluid used during arthroscopy, and decrease postoperative pain. Although several studies have shown TXA in shoulder and knee arthroscopy may decrease early pain, swelling, and hemarthrosis, others have shown no difference in short- or long-term outcomes when compared with placebo. Although there is a low reported rate of complications after TXA use in shoulder and knee arthroscopy, TXA may be chondrotoxic in high concentrations. Further investigation is warranted, but TXA may have some early benefits in arthroscopic shoulder and knee surgeries. (Journal of Surgical Orthopaedic Advances 33(3):131-134, 2024).

Development of shoulder osteoarthritis and bone lesions in female and male rats subjected to a high fat/sucrose diet.

Oligofructose prebiotic fiber supplementation has been reported to mitigate the effects of a high fat/high sucrose diet and reduce knee joint degeneration in male rats. However, few studies investigated the development of osteoarthritis and bone lesions as a function of sex and in joints other than the knee. This study was aimed at to quantifying the effect of a HFS diet and prebiotic fiber supplementation on shoulder joint health in male and female Sprague-Dawley rats. Rats were randomized into 6 groups: 2 groups fed a chow diet: Chow-Male n = 11, Chow-female n = 12; 2 groups fed a HFS diet: HFS-Male n = 11, HFS-Female n = 12; and 2 groups fed a prebiotic fiber supplement in addition to the HFS diet: Fiber-Male n = 6, Fiber- Female n = 12. After 12 weeks, shoulder joints were histologically assessed for OA. Body composition, serum lipid profile, insulin resistance and fecal microbiota were also assessed. Shoulders in male and female rats appear to be protected against degeneration when exposed to a HFS diet. Male rats developed bone lesions while females did not. Fiber supplementation was more effective in males than in females suggesting that fiber supplementation may have sex-specific effects on the gut microbiota.

Combination of different local anesthetic adjunct for supraclavicular brachial plexus block after arthroscopic shoulder surgery: a prospective randomized controlled trial.

BACKGROUND: Acute pain is a major concern after arthroscopic shoulder surgery, supraclavicular brachial plexus blockade has shown favorable postoperative analgesic effects. However, its duration of analgesia does not meet clinical needs. We aimed to explore whether the combination of different local anesthetic adjunct can prolong the analgesic duration of supraclavicular brachial plexus block for arthroscopic shoulder surgery. METHODS: In this prospective randomized controlled trial, we allocated 80 patients into four groups: Group DMD (dexamethasone 10 mg + ropivacaine 100 mg + dexmedetomidine 50 µg + magnesium sulfate 250 mg), Group DM (ropivacaine 100 mg + dexmedetomidine 50 µg + magnesium sulfate 250 mg), Group M (ropivacaine 100 mg + magnesium sulfate 250 mg) and Group D (ropivacaine 100 mg + dexmedetomidine 50 µg). The primary outcome was the time to first request for analgesia. Secondary outcome measures included cumulative opioid consumption at 6, 12, 18, 24, and 48 h postoperatively, VAS scores at 6, 12, 18, 24, and 48 h postoperatively and so on. RESULTS: The time to first request for analgesia in Group DMD was significantly longer than Group DM (P = 0.011) and Group M (P = 0.003). The cumulative opioid consumption at 18 h postoperatively in Group DMD was significantly lower than in Group DM (P = 0.002) and Group M (P = 0.007). The cumulative opioid consumption at 24 h postoperatively in Group DMD was significantly lower than in Group DM (P = 0.016). The VAS score at 6 h postoperatively in Group DMD was significantly lower than in Group DM and Group M. The VAS score at 12 h postoperatively in Group DMD was significantly lower than in Group M. For American Shoulder and Elbow Surgeons Score, Group DMD had a better score than Group DM and Group D. CONCLUSIONS: The analgesic efficacy of supraclavicular brachial plexus blockade combined with dexamethasone, magnesium sulfate, and dexmedetomidine is significantly superior to the combination of magnesium sulfate and dexmedetomidine, and significantly superior to the use of magnesium sulfate alone. TRIAL REGISTRATION: This trial was registered in Chinese Clinical Trial Registry. (ChiCTR2200061181, Date of registration: June 15, 2022, http://www.chictr.org.cn ).

Outcomes following revision of a failed primary reverse shoulder arthroplasty.

Aims: Reverse shoulder arthroplasty (RSA) has become the most common type of shoulder arthroplasty used in the UK, and a better understanding of the outcomes after revision of a failed RSA is needed. The aim of this study was to review the current evidence systematically to determine patient-reported outcome measures and the rates of re-revision and complications for patients undergoing revision of a RSA. Methods: MEDLINE, Embase, CENTRAL, and the Cochrane Database of Systematic Reviews were searched. Studies involving adult patients who underwent revision of a primary RSA for any indication were included. Those who underwent a RSA for failure of a total shoulder arthroplasty or hemiarthroplasty were excluded. Pre- and postoperative shoulder scores were evaluated in a random effects meta-analysis to determine the mean difference. The rates of re-revision and complications were also calculated. Results: The initial search elicited 3,166 results and, following removal of duplicates and screening, 13 studies with a total of 1,042 RSAs were identified. An increase in shoulder scores pre- to postoperatively was reported in all the studies. Following revision of a RSA to a further RSA, there was a significant increase in the American Shoulder and Elbow Surgeons Score (mean difference 20.78 (95% CI 8.16 to 33.40); p = 0.001). A re-revision rate at final follow-up ranging from 9% to 32%, a one-year re-revision rate of 14%, and a five-year re-revision rate of 23% were reported. The complication rate in all the studies was between 18.5% and 36%, with a total incidence of 29%. Conclusion: This is the largest systematic review of the outcomes following revision of a RSA. We found an improvement in functional outcomes after revision surgery, but the rates of re-revision and complications are high and warrant consideration when planning a revision procedure.

The effect of smoking on functional outcomes and implant survival of anatomical total shoulder arthroplasty.

Aims: We sought to compare functional outcomes and survival between non-smokers, former smokers, and current smokers who underwent anatomical total shoulder arthroplasty (aTSA) in a large cohort of patients. Methods: A retrospective review of a prospectively collected shoulder arthroplasty database was performed between August 1991 and September 2020 to identify patients who underwent primary aTSA. Patients were excluded for preoperative diagnoses of fracture, infection, or oncological disease. Three cohorts were created based on smoking status: non-smokers, former smokers, and current smokers. Outcome scores (American Shoulder and Elbow Surgeons (ASES), Constant-Murley score, Shoulder Pain and Disability Index (SPADI), Simple Shoulder Test (SST), University of California, Los Angeles activity scale (UCLA)), range of motion (external rotation (ER), forward elevation (FE), internal rotation, abduction), and shoulder strength (ER, FE) evaluated at two- to four-year follow-up were compared between cohorts. Evaluation of revision-free survival was performed using the Kaplan-Meier method to final follow-up. Results: We included 428 primary aTSAs with a mean follow-up of 2.4 years (SD 0.6). Our cohort consisted of 251 non-smokers, 138 former smokers who quit a mean 21 years (SD 14) prior to surgery (25 pack-years (SD 22)), and 39 current smokers (23 pack-years (SD 20)). At two- to four-year follow-up, former smokers had less favourable SPADI, SST, and FE strength compared to non-smokers, and current smokers had less favourable SPADI, SST, ASES score, UCLA score, Constant-Murley score, FE, abduction, and ER strength compared to non-smokers. Non-smokers exhibited higher revision-free survival rates at two, five, eight, and ten years postoperatively compared to former smokers and current smokers, who had similar rates. Conclusion: Our study suggests that smoking has a negative effect on aTSA functional outcomes that may persist even after quitting.