Frozen shoulder is a common disease in orthopaedic clinic. The main clinical manifestations were shoulder joint pain and limited active and passive activity. However, the etiology and pathogenesis of frozen shoulder are not fully understood, so people can not choose the appropriate treatment plan. In recent years, there have been a lot of exploration on the pathogenesis and treatment measures of this disease at home and abroad, but there is no unified standard for the treatment of frozen shoulder. This article summarizes the treatment methods of frozen shoulder at home and abroad in recent years, analyzes the advantages and disadvantages of non-surgical treatment and surgical treatment, in order to provide assistance for clinical practice.
Objective To simulate anterosuperior instabil ity of the shoulder by a combination of massive irreparable rotator cuff tears and coracoacromial arch disruption in cadaveric specimens, use proximally based conjoined tendon transfer forcoracoacromial l igament (CAL) reconstruction to restrain against superior humeral subluxation, and investigate its feasibility and biomechanics property. Methods Nine donated male-adult and fresh-frozen cadaveric glenohumeral joints were applied to mimic a massive irreparable rotator cuff tear in each shoulder. The integrity of the rotator cuff tendons and morphology of the CAL were visually inspected in the course of specimen preparation. Cal ipers were used to measure the length of the CAL’s length of the medial and the lateral bands, the width of coracoid process and the acromion attachment, and the thickness in the middle, as well as the length, width and thickness of the conjoined tendon and the lateral half of the removed conjoined tendon. The glenohumeral joints were positioned in a combination of 30° extension, 0° abduction and 30° external rotation. The value of anterosuperior humeral head translation was measured after the appl ication of a 50 N axial compressive load to the humeral shaft under 4 sequential scenarios: intact CAL, subperiosteal CAL release, CAL anatomic reattachment, entire CAL excision after lateral half of the proximally based conjoined tendon transfer for CAL reconstruction. Results All specimens had an intact rotator cuff on gross inspection. CAL morphology revealed 1 Y-shaped, 4 quadrangular, and 4 broad l igaments. The length of the medial and lateral bands of the CAL was (28.91 ± 5.56) mm and (31.90 ± 4.21) mm, respectively; the width of coracoid process and acromion attachment of the CAL was (26.80 ± 10.24) mm and (15.86 ± 2.28) mm, respectively; and the thickness of middle part of the CAL was (1.61 ± 0.36) mm. The length, width, and thickness of the proximal part of the proximally based conjoined tendon was (84.91 ± 9.42), (19.74 ± 1.77), and (2.09 ± 0.45) mm, respectively. The length and width of the removed lateral half of the proximally conjoined tendon was (42.67 ± 3.10) mm and (9.89 ± 0.93) mm, respectively. The anterosuperior humeral head translation was intact CAL (8.13 ± 1.99) mm, subperiosteal CAL release (9.68 ± 1.97) mm, CAL anatomic reattachment (8.57 ± 1.97) mm, and the lateral half of the proximally conjoined tendon transfer for CAL reconstruction (8.59 ± 2.06) mm. A significant increase in anterosuperior migration was found after subperiosteal CAL release was compared with intact CAL (P lt; 0.05). The translation after CAL anatomic reattachment and lateral half of the proximally conjoined tendon transfer for CAL reconstruction increased over intact CAL, though no significance was found (P gt; 0.05); when they were compared with subperiosteal CAL release, the migration decreased significantly (P lt; 0.05). The translation of lateral half of the proximally conjoined tendon transfer for CAL reconstruction increased over CAL anatomic reattachment, but no significance was evident (P gt; 0.05). Conclusion The CAL should be preserved or reconstructed as far as possible during subacromial decompression, rotator cuff tears repair, and hemiarthroplasty for patients with massive rotator cuff deficiency. If preservation or the insertion reattachment after subperiosteal release from acromion of the CAL of the CAL is impossible, or CAL is entirely resected becauseof previous operation, the use of the lateral half of the proximally based conjoined tendon transfer for CAL reconstruction isfeasible.
ObjectiveTo investigate the effectiveness of arthroscopic 360° capsular release for frozen shoulder.MethodsBetween April 2018 and April 2019, 42 patients with frozen shoulders were treated with arthroscopic 360° capsular release. There were 13 males and 29 females, with an average age of 52.3 years (range, 45-56 years). There were 14 left shoulders and 28 right shoulders. The disease duration ranged from 5 to 18 months (mean, 11.1 months). The main clinical symptoms were limited active and passive movement of the shoulder joint with severe pain. All patients excluded impingement syndrome and shoulder osteoarthritis. Preoperative range of motion was as follows: forward flexion (93.2±15.4)°, external rotation at side (15.9±6.0)°, external rotation at 90° abduction (18.4±9.9)°, and internal rotation reaching the greater trochanter in 5 cases, buttocks in 20 cases, S1 level in 17 cases. The visual analogue scale (VAS) score was 6.7±1.7 and the American Society of Shoulder and Elbow Surgery (ASES) score was 41.6±9.3. The active range of motion of shoulder joint, VAS score, and ASES score were recorded during follow-up.ResultsAll incisions healed by first intention, and no early complications occurred. Patients were followed up 12-24 months (mean, 15.6 months). After operation, forward flexion, external rotation at side, and external rotation at 90° abduction significantly improved when compared with preoperatively (P<0.05). The range of internal rotation restored to the level of T6-12 at 3 weeks, which was equivalent to that of the normal side at 12 months after operation (Z=–0.943, P=0.346). VAS scores decreased and ASES scores increased after operation, and the differences between pre- and post-operation were significant (P<0.05); and with time, the VAS scores and ASES scores improved further (P<0.05).ConclusionArthroscopic 360° capsular release can significantly increase the range of motion of the shoulder joint, release pain, and improve function. It is an effective method for the treatment of frozen shoulders.
Objective To analyze the effectiveness of tuberosity suture combined with autogenous bone grafting in reverse total shoulder arthroplasty for elderly patients with proximal humerus fracture. Methods A clinical data of 28 patients with fresh proximal humerus fractures, who met the selection criteria and admitted between June 2014 and April 2022, was retrospectively analyzed. There were 7 males and 21 females. Age ranged from 65 to 81 years, with an average of 73.8 years. The causes of injury were 21 cases of fall, 6 cases of traffic accident, and 1 case of falling from height. The time from injury to operation ranged from 5 to 20 days with an average of 9.2 days. There were 8 cases of Neer three-part fracture and 20 cases of four-part fracture. The reverse total shoulder arthroplasty was performed, and the greater and lesser tuberosities were sutered and reconstructed with autogenous bone grafting. After operation, the Constant score, American Society for Shoulder Surgery (ASES) score, and visual analogue scale (VAS) score were used to evaluate shoulder function and pain; and the active range of motion of the shoulder joint was recorded, including flexion, external rotation, and internal rotation. X-ray films were taken to observe the position of prosthesis. According to the evaluation criteria proposed by Boileau, the healing of greater tuberosity was evaluated, and the effectiveness was compared between the patients with healed and non-healed (displacement and absorption) greater tuberosity. ResultsAll incisions healed by first intention after operation. All patients were followed up 24-106 months, with an average of 60.9 months. At last follow-up, the VAS score of shoulder joint ranged from 0 to 6 (mean, 1.1). The Constant score ranged from 45 to 100 (mean, 80.1). The ASES score ranged from 57 to 100 (mean, 84.7). The active range of motions of shoulder joint were 60°-160° (mean, 118°) in flexion, 0°-50° (mean, 30°) in external rotation, and corresponding to reaching the S5-T8 vertebral body level in internal rotation. During follow-up, no shoulder joint re-dislocation or severe shoulder instability occurred, and no revision surgery was performed. X-ray film reexamination showed that there was no loosening of the prosthesis. According to the evaluation criteria proposed by Boileau, the greater tuberosity fused in 22 cases (78.6%), displaced in 3 cases (10.7%), and absorbed in 3 cases (10.7%). The shoulder joint function and pain related evaluation indicators in the healed group were significantly better than those in the non-healed group (P<0.05). ConclusionTuberosity suture combined with autogenous bone grafting is a relatively simple procedure that provides a reliable fixation for the anatomic recovery of greater and lesser tuberosities and is beneficial for the recovery of shoulder function in elderly patients with proximal humeral fractures.
Objective To review the research progress of pathological changes of glenohumeral capsule in patients with recurrent shoulder anterior dislocation (RSAD). Methods The literature on shoulder capsules, both domestic and international, was reviewed. The anatomy, histology, and molecular biology characteristics of the glenohumeral capsule in RSAD patients were summarized. Results Anatomically, the glenohumeral capsule is composed of four distinct parts: the upper, lower, anterior, and posterior sections. The thickness of these sections is uneven, and the stability of the capsule is further enhanced by the presence of the glenohumeral and coracohumeral ligaments. Histologically, the capsule tissue undergoes adaptive changes following RSAD, which improve its ability to withstand stretching and deformation. In the realm of molecular biology, genes associated with the regulation of structure formation, function, and extracellular matrix homeostasis of the shoulder capsule’s collagen fibers exhibit varying degrees of expression changes. Specifically, the up-regulation of transforming growth factor β1 (TGF-β1), TGF-β receptor 1, lysyl oxidase, and procollagen-lysine, 2-oxoglutarate 5-dioxygenase 1 facilitates the repair of the joint capsule, thereby contributing to the maintenance of shoulder joint stability. Conversely, the up-regulation of collagen type Ⅰ alpha 1 (COL1A1), COL3A1, and COL5A1 is linked to the recurrence of shoulder anterior dislocation, as these changes reflect the joint capsule’s response to dislocation. Additionally, the expressions of tenascin C and fibronectin 1 may play a role in the pathological processes occurring during the early stages of RSAD. ConclusionGlenohumeral capsular laxity is both a consequence of RSAD and a significant factor contributing to its recurrence. While numerous studies have documented alterations in the shoulder capsule following RSAD, further research is necessary to confirm the specific pathological anatomy, histological, and molecular biological changes involved.
Objective To evaluate the effectiveness of arthroscopic Pushlock anchor fixation with iliac creast bone autograft in the treatment of recurrent anterior shoulder instability with critical bone defect. Methods The clinical data of 80 patients with recurrent anterior shoulder instability with critical bone defect treated by arthroscopic Pushlock anchor fixation with iliac creast bone autograft between January 2016 and January 2019 were retrospectively analyzed. The patients were all male; they were 18-45 years old at the surgery, with an average of 25 years old. The disease duration ranged from 3 months to 5 years, with an average of 2 years. The shoulder joint dislocated 3-50 times, with an average of 8 times. X-ray films, MRI, CT scans and three-dimensional reconstruction of the shoulder were performed before operation. The area of the anterior glenoid defect was 25%-45%, with an average of 27.3%. The shoulder mobility (forward flexion and external rotation in abduction at 90°), the Constant-Murley score, and the Rowe score were used to evaluate the shoulder function before operation and at last follow-up. ResultsPatients were followed up 1-3 years, with an average of 2 years. No shoulder dislocation occurred again during follow-up. All partial graft absorption occurred after operation, CT scan showed that the graft absorption ratio was less than 30% at 1 week and 3 months after operation. CT three-dimensional reconstruction at 1 year after operation showed that all grafts had healed to the glenoid. The anterior glenoid bone defect was less than 5% (from 0 to 5%, with an average of 3.2%). At last follow-up, the shoulder mobility (forward flexion and external rotation in abduction at 90°), the Constant-Murley score, and the Rowe score significantly improved when compared with preoperative ones (P<0.05). The shoulder mobility of external rotation in abduction at 90° of the affected side limited when compared with the healthy side [(6.7±5.1)°]. ConclusionArthroscopic Pushlock anchor fixation with iliac creast bone autograft has a good effectiveness in the treatment of recurrent anterior shoulder instability with critical bone defect. The method is relatively simple and the learning curve is short.
ObjectiveTo investigate the cl inical characteristics of Eyres type V coracoid fracture combined with superior shoulder suspensory complex (SSSC) injuries, and the effectiveness of open reduction and fixation. MethodsBetween March 2004 and July 2012, 13 patients with Eyres type V coracoid fracture and SSSC injuries were treated. There were 10 males and 3 females with an average age of 41 years (range, 23-59 years). Injury was caused by fall ing from height in 4 cases, by traffic accident in 6 cases, and by impact of the heavy weight in 3 cases. The interval from injury to operation was 3-10 days (mean, 5.2 days). SSSC injuries included 9 cases of acromioclavicular joint dislocation, 5 cases of clavicular fractures, and 4 cases of acromion fractures. The coracoid fractures were fixed with cannulated screws; the acromioclavicular joint dislocations were fixed with hook plate (6 cases) or Kirschner wires (2 case) except 1 untreated case; the clavicular fractures were fixed with anatomical locking plate (3 cases) and hook plate (2 cases); the acromion fractures were fixed with cannulated screws (1 case), Kirschner wires (2 cases), or both of them (1 case). ResultsThe mean operation time was 158.0 minutes (range, 100-270 minutes), and the mean intraoperative blood loss was 207.7 mL (range, 150-300 mL). The other patients obtained primary healing of incision except 1 patient who had inflammation around incision, which was cured after change dressing. All patients were followed up for 22.6 months on average (range, 17-35 months). All fractures achieved union at a mean time of 3.6 months (range, 2-6 months). No nerve injury and implant fixation failure complications were observed. At last follow-up, the Constant score and the disabil ity of the arm, shoulder, and hand (DASH) score had a significant improvement when compared with scores at pre-operation (P<0.05). The shoulder range of motion in flexion, abduction, and external rotation at last follow-up were significantly higher than those at pre-operation (P<0.05). ConclusionEyres type V coracoid fracture associated with SSSC injuries usually results in the instabil ity of the shoulder. With individual surgical treatment, the satisfactory function and good effectiveness can be obtained.
Objective To assess the effectiveness of suture button fixation Latarjet procedure under total arthroscopy for anterior shoulder instability with severe bone defects. MethodsThe clinical data of 15 patients with severe bone defects and anterior shoulder instability treated with suture button fixation Latarjet procedure under total arthroscopy between June 2020 and February 2023 was retrospectively analyzed, including 11 males and 4 females, with an average age of 31.1 years (range, 20-54 years). Three-dimensional CT showed that the average glenoid bone defect was 24.4% (range, 16.3%-35.2%). The average number of shoulder dislocation was 4.2 times (range, 3-8 times). The disease duration ranged from 6 to 21 months with an average of 10.6 months. The operation time and intraoperative blood loss were recorded. The pain relief was evaluated by visual analogue scale (VAS) score, and the functional recovery of shoulder joint was evaluated by Rowe score, Walch-Duplay score, and American Association for Shoulder and Elbow Surgery (ASES) score before and after operation. The range of motion (ROM) of the shoulder joint was assessed, including active flexion, lateral external rotation, abduction 90° external rotation, and internal rotation. Three-dimensional CT was performed at 6 months after operation and at last follow-up to observe the absorption of bone graft, the position of bone graft and glenoid, and the healing of bone graft. Results The operation was successfully completed in all patients. The operation time was 85-195 minutes, with an average of 123.0 minutes. The intraoperative blood loss was 20-75 mL, with an average of 26.5 mL. All patients were followed up 13-32 months, with an average of 18.7 months. During the follow-up, there was no serious complication such as shoulder joint infection, joint stiffness, or vascular and nerve injury. One patient had partial absorption of the transplanted bone and bone nonunion at 3 months after operation, but the pain of the shoulder joint relieved at last follow-up, and no redislocation of the shoulder joint occurred; no obvious bone fracture or dislocation of the shoulder joint was found in the other patients. Bone union was achieved at 6 months during follow-up. At last follow-up, the VAS score, Rowe score, Walch-Duplay score, and ASES score significantly improved when compared with those before operation (P<0.05), while the ROM of active flexion, lateral external rotation, abduction 90° external rotation, and internal rotation of the shoulder joint was not significantly different from those before operation (P>0.05).ConclusionSuture button fixation Latarjet procedure under total arthroscopy can improve shoulder joint function in patients with severe anterior shoulder instability caused by bone defects, and imaging also indicates satisfactory placement of transplanted bone blocks.
ObjectiveTo investigate the effectiveness of open reduction and internal fixation for multiple injuries of superior shoulder suspensory complex (SSSC) with coracoid process fracture.MethodsBetween January 2014 and October 2018, 22 patients with multiple injuries of SSSC with coracoid process fracture were treated by open reduction and internal fixation. There were 16 males and 6 females, aged from 24 to 72 years with an average age of 36.6 years. There were 10 cases of falling injury, 5 cases of traffic accident injury, and 7 cases of falling from height injury. All of them were fresh closed injuries. The time from injury to operation ranged from 2 to 17 days with an average of 6.9 days. Both X-ray film and CT showed the coracoid process fracture complicated with clavicular fracture in 14 cases, acromioclavicular joint dislocation in 12 cases, and acromioclavicular fracture in 5 cases. There were 14 cases of two places of SSSC, 7 cases of three places of SSSC, and 1 case of four places of SSSC.ResultsAll incisions healed in primary stage after operation. All patients were followed up 10-24 months with an average of 14.1 months. X-ray films showed that all fractures healed and the acromioclavicular joint was normal. The healing time ranged from 6 to 12 months, with an average of 6.2 months. No complications such as internal fixation failure and nonunion occurred. According to University of California Los Angeles (UCLA) shoulder scoring system, the shoulder joint function was rated as excellent in 15 cases, good in 5 cases, and poor in 2 cases at last follow-up. The excellent and good rate was 90.9%.ConclusionOpen reduction and internal fixation for treatment of multiple injuries of SSSC with coracoid process fracture is firm and reliable. Combined with active postoperative rehabilitation program intervention, it can accelerate the recovery of shoulder joint function and achieve satisfactory effectiveness.
Objective To investigate the mid-term effectiveness of arthroscopic Bankart repair for recurrent anterior shoulder dislocation. Methods The clinical data of 107 patients with recurrent anterior shoulder dislocation who met the inclusion criteria between January 2017 and June 2021 was retrospectively analyzed, and all patients underwent arthroscopic Bankart repair. There were 88 males and 19 females. The age of the primary dislocation ranged from 13 to 48 years (mean, 23.3 years). The number of preoperative dislocations was 2-160 times (median, 7 times). The duration of preoperative instability was 0.2-240.0 months (median, 36.0 months). The mean age at operation was 28.2 years (range, 16-61 years). There were 43 cases of left shoulder and 64 cases of right shoulder. The proportion of glenoid defects in 63 patients was 1.7%-16.1% (mean, 8.1%). MRI showed that none of the patients had rotator cuff tears or shoulder stiffness. The CT three-dimensional reconstruction was performed at 1 day after operation to evaluate the distribution of implanted anchors and the occurrence of glenoid split fracture and whether there were nails pullout at the implant site. The postoperative complications were observed, and the pain and function of the shoulder were evaluated by visual analogue scale (VAS) score, Rowe score, Constant-Murley score, and American Shoulder and Elbow Surgeons (ASES) score. The recurrence of instability, the results of apprehension test, the number of patients who returned to preoperative sports level, and the satisfaction rate of patients were recorded. Results All patients were successfully operated and were followed up 20-73 months (mean, 41.5 months). All incisions healed by first intention. The CT three-dimensional reconstruction at 1 day after operation showed that the anchors were located at the 2 : 00-5 : 30 positions of the glenoid, and there was no glenoid split fracture or nails pullout at the implant site. At last follow-up, VAS score was significantly lower than that before operation, and Rowe score, Constant-Murley score, and ASES score were significantly higher than those before operation (P<0.05). Seven patients (6.5%) had recurrence of anterior shoulder dislocation at 23-55 months (mean, 39.9 months) after operation, including 6 cases of dislocation and 1 case of subluxation. At last follow-up, 51 patients (47.7%) returned to preoperative sports level, and 11 patients (10.3%) had a positive apprehension test. The patients’ satisfaction rate was 90.7% (97/107). Among the 10 patients who were not satisfied with the surgical effectiveness, 7 patients had postoperative recurrence of instability, and 3 patients felt that they did not return to preoperative sports level. Conclusion Arthroscopic Bankart repair has good mid-term effectiveness in patients with recurrent anterior shoulder dislocations, minimal or no glenohumeral bone defects and low sports need.