MRI as a diagnostic technique in examination of the shoulder joint

The paper presents the results of examination of 95 patients with shoulder joint abnormality to define the capacities of MR imaging in the evaluation of the anatomic structures of this joint. It details the MR anatomic features of the shoulder joint. Some conditions should be adhered to while performing MRI of the joint, namely: to obtain high-quality images by correctly choosing pulse sequences and scanning planes and to know the anatomic variants of the structure of the shoulder joint.     

MRI in shoulder joint instability

The paper provides the results of MRI studies in 100 patients having complaints of pain and impaired movements in the shoulder joint in order to establish a diagnosis. Sixty-three patients were found to have MRI signs of shoulder joint instability (SJI). The paper presents and states the found MRI symptoms of SJI. The author concludes that MRI of the shoulder joint in its instability should be used appropriately as it may early reveal changes in the articular osseous, cartilaginous, and soft tissues, which is useful in diagnosing and choosing a treatment.     

MRI in shoulder joint instability

The paper provides the results of MRI studies in 100 patients having complaints of pain and impaired movements in the shoulder joint in order to establish a diagnosis. Sixty-three patients were found to have MRI signs of shoulder joint instability (SJI). The paper presents and states the found MRI symptoms of SJI. The authors concludes that MRI of the shoulder joint in its instability should be used appropriately as it may early reveal changes in the articular osseous, cartilaginous, and soft tissues, which is useful in diagnosing and choosing a treatment.     

Development of an Arthroscopic Joint Capsule Injury Model in the Canine Shoulder

Background

The natural history of rotator cuff tears can be unfavorable as patients develop fatty infiltration and muscle atrophy that is often associated with a loss of muscle strength and shoulder function. To facilitate study of possible biologic mechanisms involved in early degenerative changes to rotator cuff muscle and tendon tissues, the objective of this study was to develop a joint capsule injury model in the canine shoulder using arthroscopy.

Methods

Arthroscopic surgical methods for performing a posterior joint capsulectomy in the canine shoulder were first defined in cadavers. Subsequently, one canine subject underwent bilateral shoulder joint capsulectomy using arthroscopy, arthroscopic surveillance at 2, 4 and 8 weeks, and gross and histologic examination of the joint at 10 weeks.

Results

The canine subject was weight-bearing within eight hours after index and follow-up surgeries and had no significant soft tissue swelling of the shoulder girdle or gross lameness. Chronic synovitis and macroscopic and microscopic evidence of pathologic changes to the rotator cuff bony insertions, tendons, myotendinous junctions and muscles were observed.

Conclusions

This study demonstrates feasibility and proof-of-concept for a joint capsule injury model in the canine shoulder. Future work is needed to define the observed pathologic changes and their role in the progression of rotator cuff disease. Ultimately, better understanding of the biologic mechanisms of early progression of rotator cuff disease may lead to clinical interventions to halt or slow this process and avoid the more advanced and often irreversible conditions of large tendon tears with muscle fatty atrophy.     

肌内效贴联合经皮神经电刺激对脑卒中后偏瘫肩痛患者肩关节疼痛、肩关节功能和血液流变学的影响

摘要 目的：探讨肌内效贴联合经皮神经电刺激（TENS）对脑卒中后偏瘫肩痛患者肩关节疼痛、肩关节功能和血液流变学的影响。方法：选取2019年5月~2022年1月期间江苏省人民医院收治的脑卒中后偏瘫肩痛患者100例,根据随机数字表法将其分为对照组（n=50）和研究组（n=50）,在常规康复训练的基础上,对照组接受肌内效贴干预,研究组接受肌内效贴联合TENS干预。对比两组视觉模拟评分法（VAS）评分、上肢Fugl-Meyer运动功能评定量表（FMA）、改良Barthel指数（MBI）、Constant-Murley肩关节功能评分量表（CMS）评分、血液流变学指标、肩关节功能变化情况。结果：研究组干预后VAS评分低于同期对照组（P<0.05）。研究组干预后FMA、MBI、CMS评分高于同期对照组（P<0.05）。研究组干预后血浆黏度、纤维蛋白原、全血黏度、红细胞压积均低于同期对照组（P<0.05）。研究组干预后患侧肩关节的外旋、前屈、外展的主动/被动活动度（AROM/PROM）均大于对照组同期（P<0.05）。结论：肌内效贴联合TENS应用于脑卒中后偏瘫肩痛患者,可有效改善肩关节疼痛、肩关节功能和血液流变学。     

锁骨远端锁定钢板治疗NeerⅡ型锁骨远端骨折的疗效及对肩关节功能恢复的影响

目的:探讨锁骨远端锁定钢板治疗NeerⅡ型锁骨远端骨折的疗效及对肩关节功能恢复的影响。方法:回顾性分析2015年7月～2017年10月期间四川省泸州市中医医院收治的107例NeerⅡ型锁骨远端骨折患者的临床资料,其中行锁骨钩钢板治疗的53例患者作为对照组,行锁骨远端锁定钢板治疗的54例患者作为研究组。比较两组术后1年的临床疗效,记录两组患者手术时间、术中出血量、手术切口长度、骨折愈合时间,比较两组术前、术后5周、术后10周肩关节功能情况,记录并发症发生情况。结果:研究组术后1年优良率为90.74%(49/54),显著高于对照组患者的64.15%(34/53)(P0.05)。两组患者手术时间、术中出血量、手术切口长度以及骨折愈合时间比较差异无统计学意义(P0.05)。两组患者术后5周、术后10周肩关节功能、肩关节活动度、X线评定、患侧肩部疼痛、关节稳定性评分高于术前,且术后10周高于术后5周(P0.05);研究组术后5周、术后10周上述指标评分高于对照组(P0.05)。研究组术后并发症总发生率为7.41%(4/54),低于对照组的32.08%(17/53)(P0.05)。结论:锁骨远端锁定钢板治疗NeerⅡ型锁骨远端骨折安全有效,可有效改善患者肩关节功能,促进术后恢复。     

An MRI Study of Symptomatic Adhesive Capsulitis

Background

Appilication of MR imaging to diagnose Adhesive Capsulitis (AC) has previously been described. However, there is insufficient information available for the MRI analysis of AC. This study is to describe and evaluate the pathomorphology of the shoulder in Asian patients with AC compared to healthy volunteers.

Methodology/Principal Findings

60 Asian patients with clinically diagnosed AC and 60 healthy volunteers without frozen shoulder underwent MRI of the shoulder joint. All subjects who were age- and sex-matched control ones underwent routine MRI scans of the affected shoulder, including axial, oblique coronal, oblique sagittal T1WI SE and coronal oblique T2WI FSE sequences. Significant abnormal findings were observed on MRI, especially at the rotator cuff interval. The coracohumeral ligament (CHL), articular capsule thickness in the rotator cuff interval as well as the fat space under coracoid process were evaluated. MRI showed that patients with adhesive capsulitis had a significantly thickened coracohumeral ligament and articular capsule in the rotator cuff interval compared to the control subjects (4.2 vs. 2.4 mm, 7.2 vs. 4.4 mm; p<0.05). Partial or complete obliteration of the subcoracoid fat triangle was significantly more frequent in patients with adhesive capsulitis compared with control subjects (73% vs. 13%, 26% vs. 1.6%; p<0.001). Synovitis-like abnormality around the long biceps tendon was significantly more common in patients with adhesive capsulitis than in control subjects. With regards to the inter-observer variability, two MR radiologists had an excellent kappa value of 0.86.

Conclusions/Significance

MRI can be used to show characteristic findings in diagnosing AC. Thickening of the CHL and the capsule at the rotator cuff interval and complete obliteration of the fat triangle under the coracoid process have been shown to be the most characteristic MR findings seen with AC.     

关节镜治疗髋关节疾病的临床研究

目的:研究髋关节镜治疗髋关节疾病的方法、疗效及适应证,探讨髋关节镜在髋关节疾病中的临床价值。方法:研究对象为86例有明显髋关节疼痛的患者,包括股骨头坏死(osteonecrosis,ON)(43%)、盂唇损伤(20%)、退行性关节病变(degenerative joint disease,DJD)(10%)、股骨头骨骺缺血性坏死(Legg-Calve'-Perthes,LCP)(10%)、髋关节游离体(10%)、髋关节疼痛(100%)、机械性损伤(78%)、运动损伤(56%)。对患者采用仰卧位进行髋关节镜检查,使用牵引床,300或700,前外侧入口。观察不同疾病在治疗后的预后结果。结果:所有患者均无并发症,平均随访时间30个月,有60%的患者疼痛症状得到缓解。盂唇(91%,P0.003)或LCP(89%,P0.05)患者疗效较好,而ON和DJD患者疼痛症状缓解较差,改善率仅为40%和44%。在吻合血管游离腓骨移植(free-vascularized fibular graft,FVEG)的患者中有34%在随访期间得到改善(P=0.003)。其中18名患者(21%)进行了全髋关节置换术。结论:髋关节镜手术对于游离体、盂唇损伤、局灶性软骨病变、晚期LCP后遗症患者有良好的治疗效果;对股骨头坏死的治疗效果不佳。     

关节镜清理术治疗前踝撞击征的疗效

目的:探讨踝关节镜对前踝撞击征的诊疗价值。方法:采用关节镜清理术治疗前踝撞击综合征33例,其中男23例,女10例。年龄平均39岁(18～72岁)。左踝16例,右踝17例。病史6个月至20年,有运动损伤史13例,踝关节扭伤病史17例,踝关节骨折史3例。临床表现为踝关节肿胀、疼痛和下蹲活动受限。X线片显示胫骨前唇和距骨骨质增生,MRI显示距骨软骨损伤,踝关节腔内积液。采用局麻关节镜下骨赘磨削,滑膜切除,踝关节清理术。结果:随访33例,平均时间35个月(4个月-6年)。术后踝关节背伸活动功能正常,按照McGuire踝关节评分系统对术前、术后踝关节功能进行评估,术前平均55分,术后平均80分,术后提高了25分。优13例,良15例,可3例,差2例,优良率84.8%。结论:局麻下踝关节镜骨赘切除、滑膜刨削和软骨修整可有效解除踝关节撞击症状,手术创伤小、功能恢复快,效果满意。     

盂肱关节骨性结构测量的研究进展

与现代人工肩关节假体设计有关的各项解剖参数测量方法很多,包括标本解剖学测量、X线平片测量、CT测量等。由于测量方法及定义线的不一致,导致较多参数测值差别太大,给肩关节假体设计及手术带来不便。本文就盂肱关节骨性结构解剖参数的测量进行综述,提出测量方法应统一到CT或MRI三维重建测量上来,以满足现代肩关节假体设计解剖与解剖关系重建的核心理念。     

The effects of biofeedback training for efficient activation of infraspinatus on proprioception and EMG activity during shoulder external rotation

The purpose of this study investigated which biofeedback (BF) training enables efficient activation of the infraspinatus muscle that affect joint position sense (JPS) and force sense (FS) of the shoulder joint. Twenty healthy males participated and performed three external rotation (ER) exercises under three randomly assigned training conditions: 1) non-biofeedback (NBF), 2) BF and 3) force biofeedback (FBF). Each exercise was performed at intervals of one week between training conditions. After performed the ER exercise under each training condition, the relative error (RE) was calculated at shoulder ER 45° and 80°, and then shoulder ER force were measured to determine the JPS error and FS error, respectively. Muscle activity of infraspinatus and posterior deltoid were measured and compared between training conditions. The RE of shoulder ER 45° and 80° were significantly lower under the FBF conditions than other training conditions (P < 0.05). The RE of shoulder ER force were also significantly lower under the FBF conditions compared to those under the other training conditions (P < 0.05). The activity of the infraspinatus muscle was significantly higher under the FBF conditions during all three ER exercises than other training conditions (p < 0.05). We suggest that BF trainings can be useful to improve the proprioception of shoulder joint as well as activation of infraspinatus muscle while performing the ER exercises.     

Characterizing upper limb muscle volume and strength in older adults: a comparison with young adults

Aging is associated with the loss of muscle volume (MV) and force leading to difficulties with activities of daily living. However, the relationship between upper limb MV and joint strength has not been characterized for older adults. Quantifying this relationship may help our understanding of the functional declines of the upper limb that older adults experience. Our objective was to assess the relationship between upper limb MV and maximal isometric joint moment-generating capacity (IJM) in a single cohort of healthy older adults (age ≥ 65 years) for 6 major functional groups (32 muscles). MV was determined from MRI for 18 participants (75.1±4.3 years). IJM at the shoulder (abduction/adduction), elbow (flexion/extension), and wrist (flexion/extension) was measured. MV and IJM measurements were compared to previous reports for young adults (28.6±4.5 years). On average older adults had 16.5% less total upper limb MV compared to young adults. Additionally, older adult wrist extensors composed a significantly increased percentage of upper limb MV. Older adult IJM was reduced across all joints, with significant differences for shoulder abductors (p<0.0001), adductors (p=0.01), and wrist flexors (p<0.0001). Young adults were strongest at the shoulder, which was not the case for older adults. In older adults, 40.6% of the variation in IJM was accounted for by MV changes (p≤0.027), compared to 81.0% in young adults. We conclude that for older adults, MV and IJM are, on average, reduced but the significant linear relationship between MV and IJM is maintained. These results suggest that older adult MV and IJM cannot be simply scaled from young adults.     

桥接组合式内固定系统结合Nice结与锁定钢板治疗锁骨中段粉碎性骨折疗效比较研究

摘要 目的：对比桥接组合式内固定系统（OBS）结合Nice结与锁定钢板治疗锁骨中段粉碎性骨折的疗效。方法：回顾性选取2021年6月至2022年1月间在我院接受治疗的锁骨中段粉碎性骨折患者（n=66）的临床资料。根据手术方式的不同将患者分为A组（锁定钢板治疗,32例）和B组（桥接组合式内固定系统结合Nice结,34例）,对比两组临床症状恢复情况、并发症发生率、视觉疼痛模拟评分（VAS）、Constant-Murley评分和肩关节活动度。结果：两组骨折愈合时间对比无差异（P>0.05）。B组术中出血量少于A组,手术时间短于A组（P<0.05）。两组术后3个月Constant-Murley评分升高,VAS评分下降（P<0.05）,B组术后3个月VAS评分低于A组,Constant-Murley评分高于A组（P<0.05）。两组术后3个月前屈、后伸、内旋、外旋的肩关节活动度增大（P<0.05）,且B组术后3个月前屈、后伸、内旋、外旋的肩关节活动度均大于A组（P<0.05）。两组并发症发生率组间比较无统计学差异（P>0.05）。结论：OBS与锁定钢板治疗锁骨中段粉碎性骨折相比,OBS结合Nice结治疗可减少术中出血量,缩短手术时间,促进骨折愈合,扩大肩关节活动度,改善肩关节功能,疗效更好。     

Modulation of shoulder muscle and joint function using a powered upper-limb exoskeleton

Robotic-assistive exoskeletons can enable frequent repetitive movements without the presence of a full-time therapist; however, human-machine interaction and the capacity of powered exoskeletons to attenuate shoulder muscle and joint loading is poorly understood. This study aimed to quantify shoulder muscle and joint force during assisted activities of daily living using a powered robotic upper limb exoskeleton (ArmeoPower, Hocoma). Six healthy male subjects performed abduction, flexion, horizontal flexion, reaching and nose touching activities. These tasks were repeated under two conditions: (i) the exoskeleton compensating only for its own weight, and (ii) the exoskeleton providing full upper limb gravity compensation (i.e., weightlessness). Muscle EMG, joint kinematics and joint torques were simultaneously recorded, and shoulder muscle and joint forces calculated using personalized musculoskeletal models of each subject’s upper limb. The exoskeleton reduced peak joint torques, muscle forces and joint loading by up to 74.8% (0.113 Nm/kg), 88.8% (5.8%BW) and 68.4% (75.6%BW), respectively, with the degree of load attenuation strongly task dependent. The peak compressive, anterior and superior glenohumeral joint force during assisted nose touching was 36.4% (24.6%BW), 72.4% (13.1%BW) and 85.0% (17.2%BW) lower than that during unassisted nose touching, respectively. The present study showed that upper limb weight compensation using an assistive exoskeleton may increase glenohumeral joint stability, since deltoid muscle force, which is the primary contributor to superior glenohumeral joint shear, is attenuated; however, prominent exoskeleton interaction moments are required to position and control the upper limb in space, even under full gravity compensation conditions. The modeling framework and results may be useful in planning targeted upper limb robotic rehabilitation tasks.     

Effects of age and sex on shoulder biomechanics and relative effort during functional tasks

Age-related decline in muscle strength can compromise shoulder function, which could increase the effort needed to perform activities of daily living (ADLs). The purpose of this cross-sectional study was to determine for the first time the relative shoulder effort during ADLs in healthy young and older adults.Ten healthy young adults and ten healthy older adults were tested for maximal isokinetic torque and on a set of ADL tasks. Using inverse dynamics, the shoulder torques during ADLs were referenced to the maximal isokinetic torque and relative effort was determined.Older compared to younger adults had >40% lower isokinetic shoulder abduction strength. The ratio of peak joint torque during six ADLs over the maximal isokinetic torque, i.e., relative effort, was higher in old (∼52%) compared with young adults (∼22%, p < 0.05). Relative effort in older adults was over 40% in overhead activities and particularly high in abduction and reaching tasks, over 60%.Healthy older compared with younger adults perform most ADL tasks involving the shoulder joint with nearly twice the level of relative effort. The concomitant reductions in maximal shoulder isokinetic torque and increases in relative effort may be related to the high prevalence of musculoskeletal pain and shoulder dysfunction in old age reported in epidemiological studies.     

前哨淋巴结活检术联合保乳治疗对早期乳腺癌患者临床疗效、术后并发症及肩关节功能的影响

目的:探讨前哨淋巴结活检术联合保乳治疗对早期乳腺癌患者临床疗效、术后并发症及肩关节功能的影响。方法:选取2014年10月至2017年2月就诊于我院的乳腺癌患者,按照患者手术方式分为联合组与对照组,其中联合组行前哨淋巴结活检手术联合保乳治疗,对照组行传统腋窝淋巴结清扫术治疗,每组各选取50例,随访时间为6个月。比较两组手术情况、并发症、乳腺美容效果及肩关节功能情况。结果:联合组手术时间、总出血量、引流管拔除时间、总引流量均明显低于对照组(P0.05)。手术治疗后,联合组并发症比例为6%,明显低于对照组38%。术后,两组患者随访6个月,联合组乳腺美容效果明显高于对照组(P0.05)。术前,两组肩关节功能各指标水平比较差异不显著(P0.05);术后,两组肩关节屈曲活动度、外旋活动度、后伸活动度、外展活动度相较于术前均明显降低(P0.05),联合组内旋活动度相较于术前降低不显著(P0.05),而对照组内旋活动度相较于术前降低显著(P0.05)。术后,联合组肩关节屈曲活动度、外旋活动度、内旋活动度、后伸活动度、外展活动度均显著高于对照组(P0.05)。结论:前哨淋巴结活检术联合保乳治疗早期乳腺癌创伤小,美容效果明显,可显著降低术后并发症发生率并减轻对患者肩关节功能的损害,远期疗效仍有待于进一步随访观察。     

药物注射联合针刀治疗肩周炎临床疗效及安全性分析

为探讨针刀联合曲安奈德、正清风痛宁、利多卡因治疗肩周炎的临床疗效及安全性分析,本研究选取2016年1月至2017年12月来东南大学附属中大医院疼痛科就诊肩周炎患者120例,随机数字表法分为药物治疗组40例(曲安奈德+正清风痛宁+利多卡因+臭氧治疗),针刀治疗组40例,综合治疗组40例(曲安奈德+正清风痛宁+利多卡因+臭氧+针刀治疗),对比分析各组治疗前后肩关节功能评分、视觉模拟评分法(visual analogue score, VAS)评分、不良反应发生率。结果显示,组内比较,3组治疗后VAS和肩关节功能评分与治疗前比较,差异具有统计学意义(p<0.001)。组间比较,治疗前3组VAS和肩关节功能评分比较,差异不具有统计学意义;综合治疗组各时间点VAS评分均低于药物及针刀治疗组,综合治疗组肩关节功能评分在治疗后1个月和2个月高于药物及针刀治疗组,差异具有统计学意义(p<0.001)。3组的不良反应发生率,差异不具有统计学意义(p>0.05)。综上所述,针刀治疗联合曲安奈德、正清风痛宁、利多卡因及臭氧在关节腔及关节周围注射治疗肩周炎安全有效,值得在临床中推广应用。     

In vivo contact areas of the knee in patients with patellar subluxation

OBJECTIVE: Ex vivo studies have suggested that cartilage contact areas and pressure are of high clinical relevance in the etiology of osteoarthritis in patients with patellar subluxation. The aims of this study were therefore to validate in vivo measurements of contact areas with 3D open magnetic resonance imaging (MRI), and to study knee joint contact areas in patients with patellar subluxation at different angles of knee flexion in comparison with healthy subjects. METHODS: 3D-MRI data sets of 12 healthy volunteers and eight patients with patellar subluxation were acquired using a standard clinical (1.5 T) and an open (0.2 T) MRI scanner. We compared femoro-patellar and femoro-tibial contact areas obtained with two different sequences from open MRI [dual-echo-steady-state (DESS) and fast-low-angle-shot (FLASH) sequences] with those derived from standard clinical 1.5 T MRI. We then analyzed differences in joint contact areas between healthy subjects and patients with patellar subluxation at 0 degree, 30 degrees, and 90 degrees of knee flexion using open MRI. RESULTS: The correlation of the size of contact areas from open MRI with standard clinical MRI data ranged from r = 0.52 to 0.92. Open-MRI DESS displayed a smaller overestimation of joint contact areas (+21% in the femoro-patellar, +12% in the medial femoro-tibial, and +19% in the lateral femoro-tibial compartment) than FLASH (+40%, +37%, +30%, respectively). The femoro-patellar contact areas in patients were significantly reduced in comparison with healthy subjects (-47% at 0 degree, -56% at 30 degrees, and -42% at 90 degrees of flexion; all p < 0.01), whereas no significant difference was observed in femoro-tibial contact areas. CONCLUSIONS: Open MRI allows one to quantify joint contact areas of the knee with reasonable accuracy, if an adequate pulse sequence is applied. The technique permits one to clearly identify differences between patients with patellar subluxation and healthy subjects at different flexion angles, demonstrating a significant reduction and lateralization of contact areas in patients. In the future, application of this in vivo technique is of particular interest for monitoring the efficacy of different types of surgical and conservative treatment options for patellar subluxation.     

Cineradiographic study of forelimb movements during quadrupedal walking in the brown lemur (Eulemur fulvus, Primates: Lemuridae)

Movements of forelimb joints and segments during walking in the brown lemur (Eulemur fulvus) were analyzed using cineradiography (150 frames/sec). Metric gait parameters, forelimb kinematics, and intralimb coordination are described. Calculation of contribution of segment displacements to stance propulsion shows that scapular retroversion in a fulcrum near the vertebral border causes more than 60% of propulsion. The contribution by the shoulder joint is 30%, elbow joint 5%, and wrist joint 1%. Correlation analysis was applied to reveal the interdependency between metric and kinematic parameters. Only the effective angular movement of the elbow joint during stance is speed-dependent. Movements of all other forelimb joints and segments are independent of speed and influence, mainly, linear gait parameters (stride length, stance length). Perhaps the most important result is the hitherto unknown and unexpected degree of scapular mobility. Scapular movements consist of ante-/retroversion, adduction/abduction, and scapular rotation about the longitudinal axis. Inside rotation of the scapula (60 degrees -70 degrees ), together with flexion in the shoulder joint, mediates abduction of the humerus, which is not achieved in the shoulder joint, and is therefore strikingly different from humeral abduction in man. Movements of the shoulder joint are restricted to flexion and extension. At touch down, the shoulder joint of the brown lemur is more extended compared to that of other small mammals. The relatively long humerus and forearm, characteristic for primates, are thus effectively converted into stride length. Observed asymmetries in metric and kinematic behavior of the left and right forelimb are caused by an unequal lateral bending of the spinal column.