Comparative Analysis of Therapeutic Outcomes Between Modified Loop Plate and Hook Plate for Treating Acute Acromioclavicular Joint Dislocation.

Objective: This study aimed to evaluate the clinical efficacy of an enhanced minimally invasive NICE joint technique combined with dual adjustable loop steel plate internal fixation for treating acute acromioclavicular joint dislocation. Methods: A retrospective analysis was conducted on 63 surgical patients treated with acute acromioclavicular joint dislocation from May 2017 to March 2022. Among them, 33 cases were treated with the clavicle hook plate, and 30 cases were treated with the minimally invasive loop plate. We compared hospitalization duration, incision length, surgical duration, intraoperative bleeding, visual analogue pain scale scores, shoulder joint Constant scores at 6 months before and after surgery, and the incidence of complications between the two groups. Results: The comparison between the two groups, including hospitalization duration, incision length, surgical duration, intraoperative bleeding volume, and shoulder joint Constant score at 6 months post-surgery, revealed statistically significant differences where the loop plate group had better results. One case (1/33) experienced postoperative complications in the hook plate group, including screw loosening and plate failure. Additionally, there were 8 cases (8/33) of subacromial osteolysis, 10 cases (10/33) of acromial impact, and 5 cases (5/33) of residual shoulder pain. Conversely, only 1 case (1/30) in the loop plate group had residual shoulder pain. Conclusions: The surgical technique involving the reconstruction of the coracoclavicular ligament using an enhanced minimally invasive NICE junction combined with double adjustable loop steel plate placement in the clavicular small bone canal is characterized by simplicity, safety, minimal invasiveness, excellent functional recovery, fewer complications, and superior clinical efficacy compared to clavicular hook steel plates.

Anatomy and Correlation of the Coracoid Process and Coracoclavicular Ligament Based on Three-Dimensional Computed Tomography Reconstruction and Magnetic Resonance Imaging.

BACKGROUND The anatomy of the coracoid process and coracoclavicular (CC) ligament have been described and the correlation between them has been assessed based on 3-dimensional computed tomography (CT) reconstruction and magnetic resonance imaging (MRI), which provide a guide for coracoclavicular ligament reconstruction. MATERIAL AND METHODS Data were collected from 300 patients who underwent both CT and MRI of the shoulder joint from January 2017 to January 2019 at the Jiang'an Hospital of Traditional Chinese Medicine. The coracoid process was observed and classified and parameters of the CC ligament were measured according to different corneal types. All of the statistics were collected and classified by 2 radiologists, and average values were determined.Measurements of segments were taken as follows: ab - In the coronal plane, the length of the CC ligament from the central point of the CC ligament at the clavicular attachment to the CC ligament at the center of the CC attachment); ac - The distance from the center point of the CC ligament at the supraclavicular attachment to the acromioclavicular joint; de - In the sagittal plane, the length of the CC ligament from the center of the clavicular attachment to the coracoid attachment point; fg - The maximum diameter of the CC ligament at the anterior and posterior margins of the clavicle attachment; hi - The largest diameter of the CC ligament at the anterior and posterior edge of the coracoid process attachment; dj - The distance of the coracoclavicular ligament from the center point of the coracoid process attachment to the coracoid process tip; kl - The distance in the supraclavicular plane from the coracoclavicular ligament to the subcoracoid process. RESULTS The analysis showed that there are 5 types of coracoid process: gourd (31%), short rod (20%), long rod (22.3%), wedge (10.3%), and water drop (6.3%). There were statistically significant differences between the lengths of the ac and hi segments in the among the wedge and gourd-type and the short rod and water drop-type coracoid processes. There were statistically significant differences between the lengths of the ab, de, and fg segments in the short rod, gourd, and long rod-type coracoid processes. There were statistically significant differences between the lengths of the ac, fg, hi, dj, and kl segments in the water drop, gourd, and long rod-type coracoid processes. CONCLUSIONS The present study indicated that measurement of the CC ligament and the different shapes of the coracoid process provide an anatomical basis for the diagnosis and treatment of shoulder diseases and the data can be used to improve the safety of CC ligament reconstruction.

Management of acromioclavicular joint disease by manual therapy versus corticosteroid injections: the protocol of a non-inferiority study.

INTRODUCTION: Degenerative acromioclavicular joint pain accounts for about 4% of shoulder pain. Various medical and non-medical treatment strategies are available for acromioclavicular joint disease but it is difficult to conduct a comparative evaluation of these treatments. The few studies dealing with the medical management of the disease have conducted no comparative assessment of drug therapies, physiotherapy, joint manipulation and corticosteroid injections. The primary goal of this study is to determine whether manual therapy is not inferior to ultrasound-guided injection of a corticosteroid preparation to decrease acromiocalvicular joint pain at 3 months. METHODS AND ANALYSIS: The acromioclavicular arthropathy managed by manual therapy is a monocentric, comparative, randomised, controlled, non-inferiority study conducted in the Rheumatology Department of Vendée Departmental Hospital, involving two parallel groups receiving either corticosteroid injections or manual therapy. The inclusion criteria are patients who suffer from pain in the shoulder or the proximal part of the arm, with pain located on palpation of the acromioclavicular joint associated with a positive cross-arm test and a positive O'Brien test. Randomisation will be at a 1:1 ratio. The injection group will receive a single ultrasound-guided injection of 1 mL of Diprostène and the manual therapy group will receive between one and three sessions at intervals of one per week. The primary outcome will be to compare the Visual Analogue Scale for pain-activity-related score at 3 months for both groups. ETHICS AND DISSEMINATION: The study project has been approved by the appropriate ethics committee (Committee for the Protection of Patients Ouest II in Angers, 30 April 2019, with the registration number of 2019/22). In agreement with current French regulations, signed informed written consent will be obtained from each patient. Results of the main trial and of the secondary endpoints will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT03951480.

Ultrasound-Guided Prolotherapy for Acromial Enthesopathy and Acromioclavicular Joint Arthropathy: A Single-Arm Prospective Study.

OBJECTIVES: Prolotherapy is an injection-based complementary treatment for various musculoskeletal diseases. The aim of this study was to evaluate the therapeutic efficacy of ultrasound-guided prolotherapy in the treatment of acromial enthesopathy and acromioclavicular joint arthropathy. METHODS: Thirty-one patients with chronic moderate-to-severe shoulder pain were recruited from September 2015 to September 2017. Ultrasound-guided prolotherapy was performed by injecting 10 mL of a 15% dextrose solution into the acromial enthesis of the deltoid or acromioclavicular joint capsule aseptically. Prolotherapy was given in 2 sessions separated by a 1-month interval. The pretreatment-to-posttreatment change in the pain visual analog scale (VAS) score was recorded as the primary outcome. The mean follow-up duration was 61.8 days. A paired t test was used to assess the difference in pretreatment and posttreatment VAS scores. A univariate logistic regression analysis was conducted to identify the demographic variables associated with substantial pain reduction after the intervention. Substantial pain reduction was defined as a posttreatment VAS score of 3 or less. RESULTS: Twenty of the 31 patients reported substantial pain reduction without adverse effects after the intervention. The mean VAS score reduction ± SD was 4.3 ± 2.6 (pretreatment, 6.8 ± 1.5; posttreatment, 2.5 ± 2.1; P < .01). CONCLUSIONS: Ultrasound-guided prolotherapy with a 15% dextrose solution is an effective and safe therapeutic option for moderate-to-severe acromial enthesopathy and acromioclavicular joint arthropathy.

Effects of 3 Different Elastic Therapeutic Taping Methods on the Subacromial Joint Space.

OBJECTIVE: The purpose of this study was to examine the effects of 3 different elastic therapeutic taping methods on the subacromial joint space in healthy adults. METHODS: Pre-/post-test laboratory study method was used in this study. Forty-eight healthy adults with no prior history of shoulder injury or surgery and no history of dominant shoulder pain in the past 6 months were enrolled in the study. Participants were placed into 3 groups (8 males and 8 females per group) on the basis of a consecutively assigned allocation design. A baseline measurement of the acromiohumeral distance (AHD) was taken by using diagnostic ultrasonography for every participant. On the basis of group assignment, participants were then taped according to the Kinesio Tape (Kinesio Tex Classic Tape) guidelines in one of 3 conditions: (1) taping of the supraspinatus from insertion to origin; (2) taping of the anterior and posterior deltoids from insertion to origin; and (3) a combination of both techniques. After a 5-minute wait period, the AHD was remeasured with the tape intervention in place, with each participant serving as his or her own control. RESULTS: Data analysis showed a statistically significant increase in AHD when using the taping technique over the anterior and posterior deltoids (Condition 2). The subacromial space increased in both males and females when the supraspinatus was taped from insertion to origin (Condition 1), but not at a statistically significant level. Condition 3, in which both taping techniques were used simultaneously, did not show an increase at a statistically significant level. CONCLUSIONS: The application of the Kinesio Tape from insertion to muscle origin of the supraspinatus or the anterior and posterior deltoid increased the subacromial joint space.

La relación de causalidad entre la manipulación de la articulación acromioclavicular y la apertura de la interlínea articular / No disponible

Introducción: El dolor de hombro es uno de los problemas músculo-esqueléticos más frecuentes en la sociedad actual, y supone una elevada carga asistencial y económica para los servicios de atención primaria. La terapia manipulativa articular se ofrece como una alternativa de tratamiento eficaz para incorporarla en el tratamiento habitual de estos pacientes, con la finalidad de reducir el dolor y mejorar la movilidad. Material y métodos: Revisión sistemática de la literatura, integrando los resultados con un informe narrativo. Resultados: Los artículos encontrados son de baja calidad metodológica. Aun así, parece que la manipulación de la articulación acromioclavicular se muestra como una técnica efectiva para el tratamiento del dolor de hombro, pudiendo objetivar los resultados del mismo mediante ecografía. Conclusiones: Es necesaria una investigación rigurosa y sistemática sobre el tema para poder concluir con precisión la efectividad de la inclusión de esta técnica en el protocolo de tratamiento del hombro doloroso

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Técnica de Snap en el tratamiento del hombro doloroso / No disponible

Introducción: El dolor de hombro es un problema importante tanto médico como socioeconómico en la sociedad occidental, debido a la cantidad de bajas laborales e incapacidades que ocasiona. La osteopatía se presenta como un tratamiento efectivo en estos casos, pudiendo objetivarse los resultados con métodos fiables como la ecografía. Material Y Métodos: Estudio observacional de serie de casos clínicos. Se describen tres casos que han sido tratados de hombro doloroso, incluyendo en el tratamiento la manipulación de la articulación acromioclavicular. Resultados: En todos los casos se ha corregido la disfunción de la articulación acromioclavicular. La movilidad y el dolor ha mejorado, si bien en uno de los casos los datos ecográficos no han sido concluyentes. Conclusiones: Es necesaria una investigación rigurosa y sistemática sobre este tema para realizar aportaciones con precisión, acerca de la efectividad de la inclusión de esta técnica en el protocolo de tratamiento del hombro doloroso, así como la objetivación de los datos mediante ecografía (AU)

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Pain relief in a young woman with adhesive capsulitis after manual manipulation of the acromioclavicular joint for remaining symptoms after mobilisation under anaesthesia.

Adhesive capsulitis is a painful condition with a prevalence of 2-5%. There is a lack of evidence for its aetiology and for conventional treatment and cost effects. This study describes the treatment effects of manual manipulation of the acromioclavicular joint for adhesive capsulitis in a young woman for persisting pain after mobilisation of the glenohumeral joint under anaesthesia. Primary outcomes were pain and physical function, measured by a visual analogue scale and the SF36 health survey. Secondary outcomes were sleep pattern, medication and perceived recovery. The mobility after manipulation under anaesthesia: elevation 55° and no improvement in pain. After manual manipulation: unrestricted elevation and significant pain relief. The patient no longer suffered from sleeping disorders and ceased all medication. Considering the lack of knowledge in aetiology and treatment, specialised manual examination of the acromioclavicular joint should be considered early in patients diagnosed with adhesive capsulitis.

Ochrobactrum anthropi septic arthritis of the acromioclavicular joint in an immunocompetent 17 year old.

Ochrobactrum anthropi is a ubiquitous, aerobic, gram-negative bacillus of low virulence, most frequently associated with nosocomial infections and infections related to indwelling catheters in immunocompromised hosts. This article presents the first reported case of O anthropi septic arthritis, here occurring at the acromioclavicular joint of an otherwise healthy patient, and provides treatment recommendations based on our experience.

Osteolysis of the distal clavicle: serial improvement and normalization of acromioclavicular joint space with conservative care.

OBJECTIVE: To discuss a case of osteolysis of the distal clavicle (ODC) in a 29-year-old male chiropractic student who showed interval radiographic and clinical evidence of healing. CLINICAL FEATURES: The patient complained of intermittent left-sided shoulder pain of 8 months' duration that was exacerbated while performing spinal-manipulative procedures. A radiographic examination showed changes consistent with osteolysis involving the distal clavicle. INTERVENTION AND OUTCOME: A conservative treatment regimen of physiotherapy, nutritional supplementation, and activity modification resulted in an interval reduction in symptomatology and radiographic findings on serial examinations, ultimately resolving both abnormal clinical and radiographic findings after approximately 14 months of treatment. We specifically observed normalization of the acromioclavicular (AC) joint dimension. CONCLUSIONS: In contrast to the posttreatment radiographic outcome seen in our patient, ODC classically does not result in complete resolution of radiographic findings or normalization of AC joint dimension, and such radiographic normalization of joint space is currently not reported in the literature. This case report serves to document and to show this unique occurrence.

[The status of therapy of acromioclavicular joint injury. Results of a survey of trauma surgery clinics in Germany]. / Stand der Therapie der Schultereckgelenkverletzung. Ergebnisse einer Umfrage an Unfallchirurgischen Kliniken in Deutschland.

The therapy of acromioclavicular dislocations remains controversial. In particular, for injuries classified as Rockwood/Tossy Type III good results have been reported with different operative techniques as well as with conservative treatment. The objective of this study was to obtain data about the current treatment for Rockwood/Tossy III injuries in German trauma departments. In a countrywide anonymous survey 210 German trauma departments were asked about their diagnostic procedures and their treatment strategies for acromioclavicular injuries. 104 questionnaires (49%) were returned and evaluated. In Rockwood/Tossy I/II injuries most clinics recommend conservative treatment (Rockwood/Tossy I/II: 99%/87%). On the other hand, 84% of the clinics would operate on Type III acromioclavicular injuries--especially in athletes or overhead workers. Although 38 percent of the clinics believe that conservative treatment is equal or better than operative treatment, only 13 percent manage Type III injuries conservatively. For more severe acromioclavicular injuries (Rockwood IV to VI) all clinics recommend an operative treatment. The operative techniques of choice for acromioclavicular injuries are K-wire fixation (37%) or a coraco-clavicular cerclage (32%). Of the latter, 73% use a resorbable material, while the remainder use wires.

[Surgical treatment of rupture of the coracoclavicular ligament and postoperative rehabilitation]. / Operacijsko lijecenje rupture korakoklavikularnog ligamenta i poslijeoperacijska rehabilitacija.

The aim of this paper is to present the results of the operative treatment of the coracoclavicular ligament. According to Tossy, the injuries are classified into thre degrees. Younger patients and sportsmen (57) with the injury of the third degree were operated in the period from 1987-2000. The diagnostic methods were clinical examination and x-ray in the frontal and sagital plane. The patients were operated by Bosworth method. The operation technique which is described is slightly modified as it facilitates the surgeon's work and gives excellent post-operative results. The immobilisation was not used in the post-operative treatment. During the first week after operation a patient does static isometric exercises using the muscles of shoulders and arms, breathing exercises and passive exercises of the arm up to pain limit. The screw was removed under the local anesthesia after minimum of 6 weeks. Upon the removal of the osteosynthetic material we applied kynetic, hydro, magnetic and electrotherapy. The results of the operation were estimated after 2.5 months. Taking into consideration the functions of coracoclavicular ligament (the regulation of angle between clavicle and shoulder-blade, the limitation of rotation and elevation of clavicle, the support in bearing arm weight, the relaxation of joint between clavicle and shoulder-blade and the lateral reinforcement of acromioclavicular joint) its complete reconstruction is very important, and with the appropriate fixation of clavicle and shoulder-blade, accompanied by physical therapy, makes the basis for good results after the operation.

Introduction of a new physical examination procedure for the differentiation of acromioclavicular joint lesions and subacromial impingement.

OBJECTIVE: To present a new physical examination procedure that may assist in differentiating acromioclavicular joint lesions from subacromial impingement lesions. DISCUSSION: The acromioclavicularjoint differential test is performed by applying downward pressure over the lateral one third of the clavicle while passively inducing slight' adduction, external rotation, and forced forward flexion to the humerus while the patient is in the seated position. Although similar mechanisms have been described, the acromioclavicular joint differential test is a new, previously unreported examination procedure. CONCLUSION: This article describes a new test to differentiate between acromioclavicular joint lesions and subacromial impingement. On the basis of its mechanism, the acromioclavicular joint differential test may provide the examiner with an additional tool in the differential diagnosis of acromioclavicularjoint lesions and subacromial impingement in the patient with shoulder pain. Although this test has been used by the author in a clinical setting, validation data are not yet available.

[Nonoperative treatment of acute, grade III acromioclavicular dislocation in judo competing athletes]. / Nieoperacyjne leczenie ostrych zwichniec III stopnia stawu barkowo-obojczykowego u zawodników wyczynowo uprawiajacych judo.

Complete acromioclavicular separation is frequent injury during practice of judo. Fourteen athletes aged 17-33 (mean 23) were treated non-operatively. All patients received cryotherapy and Velpeau bandage for two weeks, intensive rehabilitation of the shoulder followed. The patients were reviewed after mean 4.5 years (range 3-7 years). A 100-point scale designed specifically for this study, inclusive of pain, function, strength, range of motion and return to preinjury level of sports activity was used for clinical assessment. Follow-up radiographs were compared to those taken immediately after injury but no correlation with clinical results has been found. Eight results were rated excellent (90-100 points), 5 results good (80-89 points) and one result was fair (70-79 points). Short period of immobilization and early rehabilitation seems to be efficient management in highly active individuals.

[Conduction blocks in the complex treatment of humeroscapular periarthritis]. / Provodnikovye blokady v kompleksnom lechenii plechelopatochnogo periartrita.

The authors propose a method of treatment of humeroscapular periarthritis by high conduction blocks of the brachial plexus by supraclavicular approach. The influence of high conduction blocks of the brachial plexus on the peripheral circulation in the upper extremities has been studied. The results of the treatment of 192 patients with humeroscapular periarthritis (mostly) with neglected forms of the disease) are presented.

[Manual therapy and acupuncture in the treatment of neuro-dystrophic syndromes in cervical osteochondrosis]. / Manua'lnaia terapiia i iglorefleksoterapiia neiro- distroficheskikh sindromov sheinogo osteokhondroza.

The article deals with the development of a technique for the treatment of neurodystrophic syndromes of cervical osteochondrosis precluding the use of pharmacologic drugs. The technique involving microacupuncture, originally designed manual therapeutic techniques and corporal acupuncture was applied to 87 patients with neurodystrophic syndromes of cervical osteochondrosis including patients with brachioclavicular periarthrosis, brachial epicondylitis, styloiditis. The technique made it possible to obtain a therapeutic effect 1.5 to 2 times faster than using the conventional methods in these groups of patients.

Treatment of Complete Acromioclavicular Separation by Coracoclavicular Wiring / 대한정형외과학회잡지

Acromioclavicular joint injuries are frequently seen with the recent increase of traffic and industrial accidents. The treatment of complete separation of the acromioclavicular joint has been, and is still, a subject of controversy. In view of a recent trend, anatomical reduction of acromioclavicular joint, and rigid internal fixation method is preferable, especially in type 3 injury. We operated on 16 cases of complete acromioclavicular separation by the technique of coracoclavicular wiring from March 1983 to Feb. 1987. The following results were obtained. 1. The functional results were excellent; 12 cases(75%), good; 3 cases(19a%), and fair ; 1 cases(6%). 2. The complications include wire reakage ; 1 case(6%), bony erosion ; 3 cases(19%) and subluxation, 1 case(6%). 3. The advantages of coracoclavicular wiring. 1) Avoids violation of acromioclavicular joint but does not restrict rotation of the clavicle. 2) The operation is simple to perform. 3) Postoperative immobilization is minimal. 4) Removal of the wire is easy under local anesthesia. 5) This method corresponds to the coracoclavicular ligment biomechanically. Therefore, coracoclavicular wiring is thought to be a good operative method in the treatment of complete acromioclavicular separation.

Comparison of injection techniques for shoulder pain: results of a double blind, randomised study.

Seventy seven patients with soft tissue shoulder lesions including adhesive capsulitis and disorders of the rotator cuff and acromioclavicular joint were admitted to a trial comparing two different methods of corticosteroid injection with local anaesthetic in a randomly allocated double blind study. The method of anatomical injection after diagnosis by the technique of selective tissue tension gave 60% success compared with the method using tender or trigger point localisation, giving 20% success (p less than 0.001).

Impingement syndrome in the athletic shoulder.

The repetitive overhead use of the arm required by many sports may lead to impingement in the vulnerable avascular region of the supraspinatus and biceps tendons. The impingement syndrome may spill over at any time to involve the adjacent biceps tendon, subacromial bursa, and acromioclavicular joint and, as a continuum, with the passage of time, may eventuate in degeneration and partial, even complete thickness, rotator cuff tears later in life. Physical findings, particularly a positive impingement sign, confirm the diagnosis. In the young competing athlete, therapeutic measures consist of careful warm-up exercises, occasional rest by avoidance of the offending movement, and local modalities of ice, ultrasound, and transcutaneous stimulation along with anti-inflammatory medications. Surgical decompression achieved by resecting the coracoacromial ligament or a more definitive anterior acromioplasty may rarely be indicated.