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Targeted Diagnosis and Treatment of Shoulder and Elbow Disease

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (30 October 2024) | Viewed by 11366

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Special Issue Editors

Dr. Teresa Paolucci

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Guest Editor

Physical Medicine and Rehabilitation, Department of Oral Medical Sciences and Biotechnology, University of G. d'Annunzio Chieti and Pescara Chieti, 66100 Chieti, Italy
Interests: rehabilitation; chronic pain; posture and balance; neurorehabilitation; rehabilitation in musculoskeletal diseases

Dr. Massimiliano Mangone

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Guest Editor

Department of Anatomy, Histology, Forensic Medicine and Locomotor Sciences, School of Pharmacy and Medicine, Sapienza University of Rome, 00185 Rome, Italy
Interests: rehabilitation; bioengineering; biomechanics of movement and function

Special Issue Information

Dear Colleagues,

Shoulder and elbow disease includes a wide range of conditions that affect the joints, muscles, and tissues around the shoulder and elbow. Some common examples of shoulder and elbow diseases are rotator cuff tears, frozen shoulder, tennis elbow, golfer's elbow, and bursitis. Shoulder and elbow disease can cause pain and joint dysfunction that affect daily activities. The pain and disability associated with shoulder and elbow pain can have a large impact on individuals and their families, communities, and healthcare systems, affecting daily functioning and the ability to work. The diagnosis and treatment of these conditions require specialized medical attention, including personalized care that considers the patient's unique needs. Orthopedic specialists use advanced techniques to accurately diagnose the underlying issues and develop customized treatment plans that may include pain management and surgical procedures. The ultimate goal is improved function and reduced pain for patients suffering from shoulder and elbow disease. Hence, rehabilitation has a crucial role in achieving the goals described above. An individual rehabilitation plan has to follow international guidelines and requires a multidisciplinary and interdisciplinary team for its full operation, with expert physiotherapists and physiatrists in shoulder and elbow pathologies and their rehabilitation.

The primary goals of this Special Issue are to advance the targeted diagnosis and treatment of shoulder and elbow disease and trauma. We look forward to your enthusiastic participation in this Special Issue that will promote the scientific communication of our knowledge with the ultimate goal of positively influencing the treatment and care for our patients.

Dr. Teresa Paolucci
Dr. Massimiliano Mangone
Guest Editors

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Keywords

anterolateral deltoid split
joint pain
axillary nerve injury
rotator cuff injuries
shoulder arthroplasty
shoulder impingement syndrome
proximal humeral fracture
rehabilitation
exercise
physiotherapy

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Published Papers (8 papers)

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Research

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12 pages, 770 KiB

Open AccessArticle

Clinical and Structural Results Following Arthroscopic and Open Repair of Isolated Subscapularis Tears

by Christoph Bartl, Janna Dolde, Florian Gebhard, Stefan Eichhorn, Lisa Hainzer and Stephan Pauly

J. Clin. Med. 2024, 13(21), 6589; https://doi.org/10.3390/jcm13216589 - 1 Nov 2024

Viewed by 521

Abstract

Objective: With advances in techniques, arthroscopic repair of isolated subscapularis tendon tears has become increasingly popular in recent years. The aim of this study was to analyze the clinical and structural results of arthroscopic repair versus the gold standard of open repair. It is a prospective cohort study with a control group; evidence level III. Methods: In a prospective study performed at two centers, 18 patients with an isolated subscapularis tear were treated with arthroscopic repair (ARG) and 16 patients with open repair (ORG) using a uniform single-row suture anchor repair technique in both groups. The subscapularis function was assessed using specific clinical tests (belly-press and lift-off tests), strength testing and shoulder function with the use of the Constant–Murley score (CMS). Standardized magnetic resonance imaging (MRI) was used to evaluate the postoperative subscapularis muscle-tendon status. Results: At a minimum follow-up of 48 months, the CMS increased from a mean of 54 points preoperatively to a mean of 86 points postoperatively in the ARG (p < 0.01) and from 50 points to 85 points postoperatively in the ORG (p < 0.01). Specific subscapularis tests (belly-press test and lift-off test) were significantly improved from the preoperative to the postoperative status in both repair groups (p < 0.05). Despite a subscapularis tendon healing rate of over 90% on MRI scans in both repair groups, the incomplete correction of specific muscle tests was a frequent postoperative finding. Conclusions: Arthroscopic repair of isolated subscapularis tears achieved equivalent clinical and structural results compared to the gold standard of open repair. Full article

(This article belongs to the Special Issue Targeted Diagnosis and Treatment of Shoulder and Elbow Disease)

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9 pages, 2818 KiB

Open AccessArticle

Clinical and Surgical Outcomes of Shoulder Arthrodesis

by Salar Sobhi, Kieran Bochat, Grant Booth, Andrew Mattin and Sheldon Moniz

J. Clin. Med. 2024, 13(16), 4701; https://doi.org/10.3390/jcm13164701 - 10 Aug 2024

Viewed by 515

Abstract

Introduction: Shoulder arthrodesis is typically seen as a salvage procedure with limited functional objectives. In appropriately selected patients, it may effectively alleviate pain, provide stable motion, and offer patient function satisfaction. However, there have been few reports on the outcomes following shoulder arthrodesis. Methods: A multicenter, retrospective chart review of patients undergoing shoulder arthrodesis between 2001 and 2023 in Western Australia was conducted. Clinical records and imaging were then reviewed to determine patient demographics. A cross-sectional analysis of Visual Analogue (VAS), Oxford Shoulder (OSS), and American Shoulder and Elbow Surgeons Shoulder (ASES) Scores, satisfaction and complication rates was conducted. Results: In total, 14 patients with a mean age of 39.5 years (range 22–52 years, 71% male) with a mean follow-up of 7.4 years (range 3 months–18 years) were identified. The most common indications for arthrodesis included osteoarthritis (8, 57%) and instability (6, 43%). Major contributory factors were recurrent seizures (5, 36%) and multiple surgeries (4, 29%). Radiographic union was observed in 13 (93%) patients. The mean VAS was 2.8 (range 0–7), mean OSS was 33.0 (range 23–42) and ASES score was 55.4 (range 37–82). In total, 11 patients (79%) reported being satisfied. Five (36%) patients returned to theatre for complications. Conclusions: In this patient series, shoulder arthrodesis demonstrates a notable efficacy in pain reduction, high satisfaction, acceptable function, and complication rates. Full article

(This article belongs to the Special Issue Targeted Diagnosis and Treatment of Shoulder and Elbow Disease)

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12 pages, 1402 KiB

Open AccessArticle

Is the Tendon-to-Groove Ratio Associated with Elevated Risk for LHB Tendon Disorders?—A New Approach of Preoperative MR-Graphic Analysis for Targeted Diagnosis of Tendinopathy of the Long Head of Biceps

by Kristina Gerhardinger, Lisa Klute, Christian Pfeifer, Josina Straub, Laura Hechinger, Moritz Riedl, Volker Alt, Maximilian Kerschbaum and Leopold Henssler

J. Clin. Med. 2024, 13(10), 2860; https://doi.org/10.3390/jcm13102860 - 13 May 2024

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Abstract

Background: Pathologies of the long head of the biceps (LHB) tendon are a common cause of anterior shoulder pain. While the influence of the anatomical morphology of the intertubercular groove (ITG) on the development of LHB tendon instability has been investigated with ambiguous results, the relationship of the LHB to ITG anatomy has not yet been considered in this context. The objective of this study was to reliably extract the tendon-to-groove ratio from MRI scans of symptomatic patients and examine its potential influence on the occurrence of certain causes for LHB-associated symptoms. Methods: In this retrospective study, preoperative MRI scans of 35 patients (mean age of 46 ± 14 years) presenting with anterior shoulder pain and clinical indications of LHB tendinopathy were analyzed in transversal planes. Long and short diameters of the LHB tendon and ITG were measured, cross-sectional areas of the LHB tendon and ITG were calculated from these measurements, and the ratio of cross-sectional areas (LHB/ITG) was introduced. All measurements were repeated independently by three investigators and inter-rater reliability was assessed using intraclass correlation coefficient (ICC). Thereafter, tendon-to-groove ratios were compared in patients with and without intraoperative signs of LHB tendon instability. Results: All patients exhibited intraoperative signs of LHB tendinitis, with additional findings including pulley lesions and SLAP lesions. Analysis revealed variations in the dimensions of the LHB tendon and ITG cross sections, with the tendon-to-groove ratio decreasing from 37% at the pulley to 31% at the deepest point of the sulcus. Very good inter-rater reliability was observed for all measurements. The tendon-to-groove ratio did not significantly differ (p > 0.05) in patients with or without pulley lesions or SLAP lesions. Conclusions: Our study introduced the novel parameter of the tendon-to-groove ratio of cross-sectional areas as a reproducible parameter for the description of local anatomy in the field of targeted diagnosis of LHB tendon disorders. While our findings do not yet support the predictive value of the tendon-to-groove ratio, they underscore the importance of further research with larger cohorts and control groups to validate these observations. Full article

(This article belongs to the Special Issue Targeted Diagnosis and Treatment of Shoulder and Elbow Disease)

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14 pages, 2997 KiB

Open AccessArticle

AI in Hand Surgery: Assessing Large Language Models in the Classification and Management of Hand Injuries

by Sophia M. Pressman, Sahar Borna, Cesar A. Gomez-Cabello, Syed Ali Haider and Antonio Jorge Forte

J. Clin. Med. 2024, 13(10), 2832; https://doi.org/10.3390/jcm13102832 - 11 May 2024

Cited by 2 | Viewed by 1209

Abstract

Background: OpenAI’s ChatGPT (San Francisco, CA, USA) and Google’s Gemini (Mountain View, CA, USA) are two large language models that show promise in improving and expediting medical decision making in hand surgery. Evaluating the applications of these models within the field of hand surgery is warranted. This study aims to evaluate ChatGPT-4 and Gemini in classifying hand injuries and recommending treatment. Methods: Gemini and ChatGPT were given 68 fictionalized clinical vignettes of hand injuries twice. The models were asked to use a specific classification system and recommend surgical or nonsurgical treatment. Classifications were scored based on correctness. Results were analyzed using descriptive statistics, a paired two-tailed t-test, and sensitivity testing. Results: Gemini, correctly classifying 70.6% hand injuries, demonstrated superior classification ability over ChatGPT (mean score 1.46 vs. 0.87, p-value < 0.001). For management, ChatGPT demonstrated higher sensitivity in recommending surgical intervention compared to Gemini (98.0% vs. 88.8%), but lower specificity (68.4% vs. 94.7%). When compared to ChatGPT, Gemini demonstrated greater response replicability. Conclusions: Large language models like ChatGPT and Gemini show promise in assisting medical decision making, particularly in hand surgery, with Gemini generally outperforming ChatGPT. These findings emphasize the importance of considering the strengths and limitations of different models when integrating them into clinical practice. Full article

(This article belongs to the Special Issue Targeted Diagnosis and Treatment of Shoulder and Elbow Disease)

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10 pages, 5196 KiB

Open AccessArticle

Classification and Incidence of Heterotopic Ossifications in Relation to NSAID Prophylaxis after Elbow Trauma

by Diane Leyder, Stefan Döbele, Christian Konrads, Tina Histing, Cornelius S. Fischer, Marc-Daniel Ahrend and Patrick Ziegler

J. Clin. Med. 2024, 13(3), 667; https://doi.org/10.3390/jcm13030667 - 24 Jan 2024

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Abstract

Heterotopic ossification (HO) after elbow trauma can be responsible for significant motion restrictions. The study’s primary aim was to develop a new X-ray-based classification for HO of the elbow. This retrospective study analyzed elbow injury radiographs from 138 patients aged 6–85 years (mean 45.9 ± 18) who underwent operative treatment. The new classification was applied at 6 weeks, 12 weeks, and 6 months postoperatively. The severity of HO was graded from 0 to 4 and localization was defined as r (radial), p (posterior), u (ulnar) or a (anterior) by two observers. The patients were categorized based on injury location and use of non-steroidal anti-inflammatory drugs (NSAIDs) for HO prophylaxis. The correlations between the generated data sets were analyzed using Chi-square tests (χ²) with a significance level of p < 0.05. The inter- and intraobserver reliability was assessed using Cohen’s Kappa. In 50.7% of the evaluated X-rays, the formation of HO could be detected after 12 weeks, and in 60% after 6 months. The analysis showed a significant correlation between the injury’s location and the HO’s location after 12 weeks (p = 0.003). The use of an NSAID prophylaxis did not show a significant correlation with the severity of HO. The classification showed nearly perfect inter- (κ = 0.951, p < 0.001) and intrareliability (κ = 0.946, p < 0.001) according to the criteria of Landis and Koch. Based on the presented classification, the dimension and localization of HO in the X-ray image can be described in more detail compared to previously established classifications and, thus, can increase the comparability of results across studies. Full article

(This article belongs to the Special Issue Targeted Diagnosis and Treatment of Shoulder and Elbow Disease)

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8 pages, 213 KiB

Open AccessArticle

Minimum Clinically Important Difference (MCID) and Patient Acceptable Symptomatic State (PASS) Applied to the SF-36 in Patients Who Underwent Arthroscopic Rotator Cuff Repair

by Umile Giuseppe Longo, Sergio De Salvatore, Ilaria Piergentili, Alberto Lalli, Benedetta Bandini and Vincenzo Denaro

J. Clin. Med. 2024, 13(1), 178; https://doi.org/10.3390/jcm13010178 - 28 Dec 2023

Cited by 1 | Viewed by 1760

Abstract

The 36-Item Short-Form Health Survey questionnaire (SF-36) is a reliable tool to assess the health-related quality of life of patients. If a mean difference between pre-operative evaluation and final follow-up is found to be statistically significant, then the change in score is not random. However, a statistically significant mean change may not correspond to a clinical amelioration for the patient or mean that the patient’s state of health is to be considered acceptable. For this reason, interest in the concepts of minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) has grown within recent years. The goal of the present work of research was to determine the MCID and PASS values for the SF-36 in patients who received rotator cuff repair (RCR). Forty-six patients (18 women and 28 men, mean age 58.5 ± 12.9) previously diagnosed with rotator cuff disease were enrolled. All of these patients underwent RCR. They were evaluated pre-operatively and six months after the surgical intervention as a final follow-up. The SF-36 questionnaire was assessed at each evaluation. The MCID cut-offs of the total, physical, and mental dimensions of the SF-36 for patients who underwent RCR were 23.1, 32.5, and 18.1, respectively. A 23.1 improvement in the SF-36 score at six months following RCR can be correlated with patients having reached a clinically significant improvement in health status. If 81.9 or more is attained in the SF-36 score after surgical repair, the symptom state can be judged as satisfactory by the majority of patients. Full article

(This article belongs to the Special Issue Targeted Diagnosis and Treatment of Shoulder and Elbow Disease)

Review

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17 pages, 505 KiB

Open AccessReview

Comparison of Early versus Traditional Rehabilitation Protocol after Rotator Cuff Repair: An Umbrella-Review

by Teresa Paolucci, Francesco Agostini, Marco Conti, Sara Cazzolla, Elena Mussomeli, Gabriele Santilli, Federica Poso, Andrea Bernetti, Marco Paoloni and Massimiliano Mangone

J. Clin. Med. 2023, 12(21), 6743; https://doi.org/10.3390/jcm12216743 - 25 Oct 2023

Cited by 2 | Viewed by 2578

Abstract

Rehabilitation after rotator cuff repair is crucial for functional recovery and for minimizing the risk of retear. There are two rehabilitation protocols (early and traditional) and the debate about which is the best is open. This umbrella review aimed to compare the effect of these rehabilitation protocols in terms of reduction in pain, functional recovery, and retear risk. We selected systematic reviews and meta-analyses published between 2012 and 2022 dealing with the aim. Nineteen systematic reviews were included. No significant differences were found between early and traditional protocols in terms of pain reduction. Early rehabilitation provided better short-term results regarding Range of Motion improvement, but long-term functional outcomes were similar. Retear risk remains a significant concern for the early protocol. We found major differences between the analyzed protocols. This review suggests that both protocols are useful to recover global shoulder function, but the standard protocol has a greater safety profile for larger tears. On the other hand, the early protocol may be preferable for smaller lesions, allowing a faster recovery and having less impact on medical costs. Further research is needed to identify optimal rehabilitation strategies tailored to the individual patient’s needs and characteristics. Full article

(This article belongs to the Special Issue Targeted Diagnosis and Treatment of Shoulder and Elbow Disease)

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Other

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11 pages, 5127 KiB

Open AccessCase Report

Tackling Kinesiophobia in Chronic Shoulder Pain: A Case Report on the Combined Effect of Pain Education and Whole-Body Cryostimulation

by Angelo Alito, Mariachiara Elisabetta Cifalinò, Jacopo Maria Fontana, Federica Verme, Paolo Piterà and Paolo Capodaglio

J. Clin. Med. 2024, 13(7), 2094; https://doi.org/10.3390/jcm13072094 - 3 Apr 2024

Cited by 2 | Viewed by 1670

Abstract

Background: Chronic shoulder pain may cause significant functional disability and reduced psychosocial well-being. Detailed Case Description: In this case, we propose the use of pain neuroscience education and whole-body cryostimulation (WBC) to treat a 64-year-old woman with severe functional limitations and chronic right shoulder pain. The aim was to overcome kinesiophobia and improve her motor function, autonomy, and quality of life. Functional and clinical assessments were conducted at admission, discharge, and at a one-month follow-up via phone call. The patient’s global health, shoulder function, and quality of life showed improvement during hospitalisation and were maintained after one month. Discussion: Pain education is crucial in managing chronic shoulder pain, especially in addressing kinesiophobia and promoting positive patient outcomes. In this context, WBC was used as a supplementary treatment to traditional pain relief and exercise tolerance therapies. This can help individuals to participate more actively in their rehabilitation process, ultimately promoting functional recovery and an improved quality of life. Conclusion: The combination of cryostimulation, tailored physical exercises, pain education, manual therapy, and psychological support created a synergistic effect that addressed both the physical and psychological aspects of pain and kinesiophobia. Full article

(This article belongs to the Special Issue Targeted Diagnosis and Treatment of Shoulder and Elbow Disease)

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