Histological changes and neural elements in the subacromial bursa on patients with rotator cuff tear: Pilot study.

OBJECTIVE: This study aimed to investigate the neural elements of the subacromial bursa (SAB) in rotator cuff tears. MATERIALS AND METHODS: Twenty patients with rotator cuff tears were recruited, and their visual analog scale (VAS) score, duration of symptoms, and range of motion (ROM), including flexion, external rotation, and internal rotation were evaluated. Tear size was measured using magnetic resonance imaging (MRI). The SAB specimens obtained during arthroscopic rotator cuff repair were studied using routine hematoxylin and eosin staining and immunohistochemistry (S-100 protein and PGP 9.5 protein). The SAB specimen for the control group was obtained from 2 fresh cadavers and 2 patients with acute humeral shaft fracture. The Mann-Whitney U test was applied to assess the difference between histological findings of the rotator cuff tear group and control group. The correlation between the histological findings and clinical features was evaluated using the Spearman correlation coefficient. RESULTS: The mean duration of symptom was 10.2 ± 6.4 months. The preoperative average VAS score was 2.9 ± 1.2. The degrees of preoperative ROM in forward flexion and external and internal rotations were 143.8 ± 19.5, 49.5 ± 23.1, and -4.3 ± 4.2, respectively. The tear was 2.0 ± 0.9 cm. For histological findings, the number of neural elements per low power field in the rotator cuff tear group was significantly less than the control group in both immunohistochemical stainings (S-100: 0.5 ± 0.7 vs 2.8 ± 0.5, p < .01; PGP 9.5: 0.4 ± 0.7 vs 3.5 ± 0.6, p < .01). During the correlation analysis, the number of neural elements in the PGP 9.5 staining was negatively correlated with the ROM in forward flexion and external rotation. CONCLUSION: This study revealed that chronic rotator cuff tears may induce degeneration of neural elements in SAB.

Effects of Microcurrent on Oxygen Saturation by Controlling Rectus Abdominis Activity in Preterm Infant With Desaturation During Feeding: A Pilot Study.

Objective: To determine whether a portable microcurrent therapy device (PMTD) of the rectus abdominis muscles is effective for treating desaturation during feeding in preterm infants and to evaluate the association between initial electrical activity of respiratory muscle and long-term development delay. Methods: Twenty preterm infants with desaturation during feeding were recruited. Respiratory muscle activity was quantified by calculating the root mean square (RMS) of the electromyography. All preterm infants received a 30 min PMTD application to the rectus abdominis and diaphragm daily for 2 weeks. RMS of diaphragm and rectus abdominis, feeding volume, frequency of desaturation during feeding at baseline (pre-PMTD) and 1, 2 week post-PMTD were measured. The number of days it took to treat desaturation after PMTD was measured. A Denver developmental screening test was performed and infants were divided into 3 groups: (1) normal; (2) caution; and (3) delayed at 3months after PMTD. Results: The desaturation during feeding of all the preterm infants subsided after PMTD and the mean days took to treat desaturation was 25.4 ± 14.2 days. The RMS of diaphragm, rectus abdominis, and frequency of desaturation during feeding were significantly decreased and the feeding volume was significantly increased after PMTD (p < 0.01). The mean treatment duration for desaturation was negatively correlated with RMS of rectus abdominis at baseline and 1 week post-PMTD, respectively (Pearson's correlation coefficient = -0.461,-0.514, p-value = 0.047, 0.029). RMS of rectus abdominis of Group 3 is lower than that of group 1 and 2 (p < 0.01). Conclusions: This pilot study showed that the microcurrent therapy of rectus abdominis is an efficient therapy for the treatment of preterm infants with desaturation during feeding, especially preterm infants with higher activity of the rectus abdominis. In preterm infants with lower rectus abdominis activity, longer time is required to treat desaturation by microcurrent therapy and developmental delay is observed at months post-treatment.

Botulinum Toxin a Injection Combined with Radial Extracorporeal Shock Wave Therapy in Children with Spastic Cerebral Palsy: Shear Wave Sonoelastographic Findings in the Medial Gastrocnemius Muscle, Preliminary Study.

Therapeutic strategies to boost the effect of botulinum toxin may lead to some advantages, such as long lasting effects, the injection of lower botulinum toxin dosages, fewer side effects, and lower costs. The aim of this study is to investigate the combined effect of botulinum toxin A (BTA) injection and extracorporeal shock wave therapy (ESWT) for the treatment of spasticity in children with spastic cerebral palsy (CP). Fifteen patients with spastic CP were recruited through a retrospective chart review to clarify what treatment they received. All patients received a BTA injection on gastrocnemius muscle (GCM), and patients in group 1 underwent one ESWT session for the GCM immediately after BTA injection and two consecutive ESWT sessions at weekly intervals. Ankle plantar flexor and the passive range of motion (PROM) of ankle dorsiflexion were measured by a modified Ashworth scale (MAS) before treatment and at 1 and 3 month(s) post-treatment. In group 1, the shear wave velocity (SWV) of GCM was measured. The PROM and MAS in group 1 and 2 before treatment significantly improved at 1 and 3 month(s) after treatment. The change in PROM was significantly different between the two groups at 1 and 3 month(s) after treatment. The SWV before treatment significantly decreased at 1 month and 3 months after treatment in group 1. Our study has shown that the combination of BTA injection and ESWT would be effective at controlling spasticity in children with spastic CP, with sustained improvement at 3 months after treatment.

Clinical, Radiographic, and Ultrasound Findings Between Simple and Complicated Baker's Cysts.

PURPOSE: The aim of the study was to compare the clinical, radiographic, and ultrasound findings between simple and complicated Baker's cysts. METHODS: Forty-seven knees with Baker's cysts in 45 patients with knee pain were identified from a chart review. Baker's cysts were classified as simple or complicated according to ultrasound findings. Clinical data, including duration of knee pain, visual analog scale score, Kellgren-Lawrence grade, ultrasound findings, including the size and sonomorphology of the BC, severity of osteophytosis, thickness of joint effusion, meniscal tear, and synovial proliferation of the two types of BC, were compared. RESULTS: There were 22 knees with a simple cyst and 25 knees with a complicated cyst. The thickness of the suprapatellar effusion in complicated Baker's cysts (5.7 ± 3.0 mm) was significantly greater than that in simple Baker's cysts (3.8 ± 3.2 mm), and the presence of synovial proliferation in the suprapatellar recess was significantly higher in complicated Baker's cysts (22 knees, 88.0%) than in the simple Baker's cysts (12 knees, 54.5%). However, there were no significant differences in demographic, radiographic, and other ultrasound parameters between the two types of BC. CONCLUSIONS: Synovial proliferation with larger effusion in the suprapatellar recess was more associated with complicated BC than simple BC.

Comparison of Therapeutic Effectiveness Between Shoulder Distention Arthrography With Translation Mobilization and Distention Arthrography Alone in Patients With Frozen Shoulder.

OBJECTIVE: To evaluate the efficacy of distention arthrography (DA) alone and in combination with translational mobilization (TM) for treatment of patients with frozen shoulder (FS). METHODS: Eighty-five patients diagnosed with unilateral FS (freezing or frozen stage) were included. Forty-one patients were treated with DA and TM (group 1) and 44 patients with DA alone (group 2). Clinical assessments including visual analogue scale (VAS), Cyriax stage, and shoulder passive range of motion (PROM) including forward flexion, abduction, external rotation, and internal rotation were measured at baseline, 1 month, and 3 months following treatment. RESULTS: There were no significant differences in gender, side affected, symptom duration, presence of diabetes mellitus, VAS score, Cyriax stage, or shoulder PROM between the two patient groups at baseline. Compared with baseline metrics, patients in both groups demonstrated significantly improved outcome parameters at two post-treatment time points. However, mean all shoulder PROMs were significantly greater, and mean VAS score and Cyriax stage were lower in patients treated with DA and TM than in those treated with DA alone group at two post-treatment time points. At these times, mean interval change of all outcome parameters was significantly greater with DA and TM than DA alone. No serious complications were observed following treatment in either patient group. CONCLUSION: Compared with DA alone, DA combined with TM more effectively alleviates shoulder pain and increases PROM in patients with freezing or frozen stage FS.

Shear wave sonoelastography in infants with congenital muscular torticollis.

Congenital muscular torticollis (CMT) is characterized by shortening or excessive contraction of the sternocleidomastoid muscle (SCM). The main purpose of this study was to evaluate the feasibility of quantifying SCM stiffness using acoustic radiation force impulse (ARFI) sonoelastography in infants with CMT. Twenty infants with an SCM thickness greater than 10 mm with or without involvement of the entire SCM length (limitation of neck rotation passive range of motion [PROM]: group 1S >30°, group 1M = 15°-30°) and 12 infants with an SCM thickness smaller than 10 mm with or without involvement of any part of SCM (group 2) were included. The SCM thickness was measured using real time B-mode ultrasound, and the local SCM shear wave velocity (SWV) and subcutaneous fat layer using ARFI sonoelastography. The neck rotation PROM was significantly greater in group 1S (36.5°â€Š±â€Š5.3°) than in group 1M (18.8°â€Š±â€Š4.9°; P < .01); the SWV of the SCM in the affected side (2.96 ±â€Š0.99 m/s) was significantly higher than that in the unaffected side (1.50 ±â€Š0.30 m/s; P < .01) in group 1. The SWV of the SCM was significantly higher in group 1S than in group 1M. There was significant correlation between the degree of PROM deficit of neck rotation and the SWV of the affected SCM (r = .75; P < .01) in all infants. This study revealed a difference in the SWV of the affected SCM in relationship to the limitation of neck rotation PROM in infants with CMT, if there was no difference in SCM thickness among infants.

Do the Findings of Magnetic Resonance Imaging, Arthrography, and Ultrasonography Reflect Clinical Impairment in Patients With Idiopathic Adhesive Capsulitis of the Shoulder?

OBJECTIVE: To investigate the correlation between arthrography, magnetic resonance imaging (MRI), and ultrasonography (US) findings in patients with idiopathic adhesive capsulitis (IAC) of the shoulder and their clinical presentation as well as functional impairment. DESIGN: Cross-sectional observational study. SETTING: Institutional practice. PARTICIPANTS: Patients (N=75) with a clinical diagnosis of unilateral IAC. INTERVENTIONS: Contrast-enhanced MRI, single-contrast arthrography, and US were performed in all patients. MAIN OUTCOME MEASURES: The thickness of the axillary recess, coracohumeral ligament (CHL), and enhanced portion in the rotator cuff interval was measured using MRI. Arthrography was used to calculate the total score of shoulder arthrographic criteria. US was used to measure the thickness of the inferior glenohumeral ligament (IGHL) and CHL, and the IGHL ratio and CHL ratio were calculated by comparing those of the unaffected side. RESULTS: None of the MRI parameters was correlated with clinical assessment scores. The total score of shoulder arthrographic criteria was negatively correlated with passive range of motion of the total shoulder motion (P<.05), shoulder forward flexion (P<.05), and abduction (P<.05). The total Constant-Murley score was well correlated with the total score of shoulder arthrographic criteria (P<.05). The total shoulder joint space capacity was positively correlated with passive range of motion of the total shoulder motion (P<.05) and shoulder forward flexion (P<.05). The IGHL thickness, IGHL ratio, CHL thickness, and CHL ratio were negatively correlated with shoulder external rotation (P<.05). CONCLUSIONS: The findings of arthrography and US in patients with IAC of the shoulder were correlated with clinical assessment scores, whereas all measuring parameters on MRI were not. US is recommended as the preferred option for diagnosing IAC of the shoulder because it is noninvasive, reflects the clinical features of IAC, and provides anatomical accuracy.

Therapeutic Effect of Microcurrent Therapy in Children With In-toeing Gait Caused by Increased Femoral Anteversion: A Pilot Study.

OBJECTIVE: To investigate the efficacy of portable microcurrent therapy device (PMTD) of the hip internal rotators in the treatment of in-toeing gait caused by increased femoral anteversion in children over 8 years of age. METHODS: Eleven children (22 legs; 4 boys and 7 girls; mean age, 10.4±1.6 years) with in-toeing gait caused by increased femoral anteversion were included in the present study. All children received 60 minutes of PMTD (intensity, 25 µA; frequency, 8 Hz) applied to the hip internal rotators daily for 4 weeks. Hip internal rotation (IR) angle, external rotation (ER) angle, and midmalleolar-second toe angle (MSTA) measurement during stance phase at transverse plane and Family Satisfaction Questionnaire, frequency of tripping and fatigue like pains about the PMTD were performed before treatment and at 4 weeks after initial PMTD treatment. Paired t-test and Fisher exact test were used for statistical analysis. RESULTS: Hip IR/ER/MSTA was 70.3°±5.4°/20.1°±5.5°/-11.4°±2.7°, and 55.7°±7.8°/33.6°±8.2°/-2.6°±3.8° before treatment and at 4 weeks after initial PMTD treatment, respectively (p<0.01). Ten of 11 (91%) children's family stated that they were generally satisfied with the PMTD treatment. The frequency of tripping and fatigue like pains was significantly lower at 4 weeks after PMTD treatment (p<0.05). Excellent inter-rater and intra-rater reliability was observed for repeated MSTA measurements between the examiners (k=0.91-0.96 and k=0.93-0.99), respectively. CONCLUSION: PMTD of the hip internal rotators can be effective in improving the gait pattern of children with in-toeing gait caused by increased femoral anteversion.

Ultrasonographic measurement of the axillary recess thickness in an asymptomatic shoulder.

PURPOSE: The purpose of this study was to measure the axillary recess (AR) thickness in an asymptomatic shoulder by using ultrasonography (US) and to analyze the factors affecting it. METHODS: We recruited 141 patients (52 males; 89 females; age, 57.7±9.9 years) with unilateral shoulder pain and performed US on the unaffected shoulder. Two physiatrists measured the AR thickness of the unaffected shoulder independently. All patients were examined in an upright sitting position with 90° shoulder abduction. The ultrasonographic transducer was placed longitudinally on the mid-axillary line and along the long axis of the humeral shaft. The factors affecting the AR thickness values were analyzed, and intra-class correlation coefficients were used for assessing the reproducibility of each measurement. RESULTS: The intrarater reliability values for the two physiatrists were 0.98 and 0.96, respectively. The inter-rater reliability of the mean AR thickness measurements was 0.91. The mean AR thickness in all subjects, males, and females was 2.8±0.6 mm, 3.1±0.6 mm, and 2.6±0.5 mm (P<0.01), respectively. No difference between the left and the right sides (males, P=0.086; females, P=0.535) or between the dominant and the non-dominant sides (males, P=0.173; female, P=0.244) was found. The AR thickness correlated positively with the height (r=0.313, P<0.01) and the weight (r=0.319, P<0.01). However, it did not correlate with the body mass index (r=0.152, P=0.077) or the age (r=-0.056, P=0.515). CONCLUSION: US measurements of the AR thickness in asymptomatic shoulders demonstrated excellent intrarater and inter-rater reliabilities. The AR thickness showed anatomical variation with sex, height, and weight.