Search Results (74)

Introduction: Shoulder pain is one of the leading causes of medical consultation, highlighting the need to identify the most frequently affected tissues to improve diagnosis. This study aims to determine the most common shoulder soft tissue injuries in young adults using musculoskeletal ultrasound (US). Methods: An observational cross-sectional study was conducted with 66 individuals aged 18 to 45 years; 35 participants reported shoulder pain and 31 did not. All participants received shoulder US by a specialist. Structures analyzed included the rotator cuff tendons, the long head of the biceps tendon (LHBT), and the subacromial–subdeltoid bursa. Results: The supraspinatus tendon was the most frequently affected structure, accounting for 65.1% of clinical findings, and its involvement was strongly associated with subscapularis tendinitis (OR = 18.45). The subscapularis tendon represented 31.8%, tenosynovitis of the LHBT occurred in 7.6%, and the subacromial–subdeltoid bursa was affected in 1.5%. Cluster analysis revealed three distinct profiles based on age, pain status, and tendon involvement: Cluster 1 (n = 23; mean age 21.6 ± 3.8 years) included younger individuals with minimal pain and tendinopathy (21.7%); Cluster 2 (n = 21; mean age 33.6 ± 2.6) consisted of intermediate-age participants with moderate pain and predominant supraspinatus tendinitis (71.4%); and Cluster 3 (n = 22 mean age 42.1 ± 1.6) comprised older individuals with the highest prevalence of pain and combined tendon lesions (81.8%). Conclusions: This study confirms the clinical value of musculoskeletal US in detecting soft tissue injuries, including subclinical findings. The supraspinatus tendon was the most frequently affected structure, often associated with subscapularis tendinitis and other combined lesions in older individuals. US proved useful in identifying distinct injury profiles based on age and pain status, supporting its role in early diagnosis and tailored management strategies. Full article

Background/Objectives: This study investigates the benefits of incorporating stem cell therapy into arthroscopic rotator cuff repair by evaluating its impact on postoperative pain and functional recovery. Methods: A retrospective, comparative analysis was conducted with a small cohort of patients undergoing rotator cuff surgery, divided into two groups: one receiving adjunctive combined PRP and bursal stem cell therapy and the other undergoing standard arthroscopic repair alone. The outcomes were assessed using visual analog scale (VAS) scores for pain and the Constant–Murley score (CMS), which includes strength of abduction, VAS pain, limitation and range of motion, evaluated at baseline, 1, 2, 3 and 6 months postoperatively. Results: Patients in the stem cell group experienced significantly greater reductions in pain scores and more substantial improvements in functional scores at the follow-up points compared to the control group. A linear mixed-effects analysis showed that in the early postoperative period, the use of PRP and bursal stem cell therapy was associated with significantly reduced postoperative VAS pain scores (F 4.8, p = 0.045) and an increased CMS regarding postoperative pain (F 8.6, p = 0.01), alongside painless elevation level (F 6.5, p = 0.022), forward flexion (F 8.5, p = 0.01) and abduction scores (F 8.3, p = 0.011). The effect of PRP and bursal stem cell therapy remains constant during late follow-up, from the fourth to sixth postoperative month, with postoperative CMS regarding pain remaining statistically significantly higher in the stem cell therapy group (F 4.8, p = 0.008), alongside reduced night-time pain (F 7.4, p = 0.015), improved recreation ability (F 4.8, p = 0.044) and reduced activity restriction (F 5.8, p = 0.028). Conclusions: The findings suggest that the addition of stem cell therapy to arthroscopic rotator cuff repair may enhance postoperative recovery by alleviating pain and promoting functional gains. Full article

Objectives: Shoulder injury prevalence appears to be the highest among all injuries in CrossFit (CF) athletes. Nevertheless, there is no evidence deriving from prospective studies to explain this phenomenon. The purpose of this study was to document shoulder injury incidence in CF participants over a 12-month period and prospectively investigate the risk factors associated with their demographic, epidemiological, and functional characteristics. Methods: The sample comprised 109 CF athletes in various levels. Participants’ data were collected during the baseline assessment, using a specially designed questionnaire, as well as active range of motion, muscle strength, muscle endurance, and sport-specific tests. Non-parametric statistical tests and inferential statistics were employed, and in addition, linear and regression models were created. Logistic regression models incorporating the study’s continuous predictors to classify injury occurrence in CF athletes were developed and evaluated using the Area Under the ROC Curve (AUC) as the performance metric. Results: A shoulder injury incidence rate of 0.79 per 1000 training hours was recorded. Olympic weightlifting (45%) and gymnastics (35%) exercises were associated with shoulder injury occurrence. The most frequent injury concerned rotator cuff tendons (45%), including lesions and tendinopathies, exhibiting various severity levels. None of the examined variables individually showed a statistically significant correlation with shoulder injuries. Conclusions: This is the first study that has investigated prospectively shoulder injuries in CrossFit, creating a realistic profile of these athletes. Despite the broad spectrum of collected data, the traditional statistical approach failed to identify shoulder injury predictors. This indicates the necessity to explore this topic using more sophisticated techniques, such as advanced machine learning approaches. Full article

Rotator cuff tears are a leading cause of shoulder pain and dysfunction, yet the molecular mechanisms that link tendon injury to inflammation and nociceptive signaling remain poorly understood. Netrin-1, a classical axon guidance cue signaling through dependence receptors UNC5B and Neogenin-1, has been implicated in both neuronal plasticity and inflammatory processes, but its role in tendon pathology has not been explored. A rat supraspinatus tear model was employed to assess, in vivo, the expression of genes encoding netrin-1 (Ntn1) and its receptors (Unc5b and Neo1) at 0, 7, 14, 28, and 56 days post-injury (n = 10 per time point). Primary rat tenocytes isolated from rotator cuff tissue were treated in vitro with recombinant netrin-1, and transcriptional changes in genes encoding TNF-α (Tnfa), IL-6 (Il6), MMP-1 (Mmp1), and MMP-3 (Mmp3) were quantified by qRT-PCR. Separately, human iPSC-derived sensory neurons were exposed to netrin-1, and dose- and time-dependent effects on neurite outgrowth were measured at 4 and 14 days in culture. In injured tendons, Ntn1 mRNA increased significantly at day 14 (p = 0.010) and 28 (p = 0.042), Unc5b at day 7 (p = 0.002) and 14 (p < 0.001), and Neo1 at day 14 (p < 0.001) versus intact controls. Tenocyte exposure to 500 ng/mL netrin-1 induced transient upregulation of Tnfa (3 h, p = 0.023; 6 h, p = 0.009) and Il6 (3 h–24 h, all p < 0.013), as well as Mmp3 (3–24 h, p < 0.043) and Mmp1 (6 h–24 h, p < 0.024); no induction was observed at 50 ng/mL. In sensory neurons, 50 ng/mL of netrin-1 enhanced neurite extension at day 4 (p = 0.006) but not at 500 ng/mL or at day 14 for either dose. Netrin-1 and its receptors are upregulated in a rat rotator cuff tear model, and netrin-1 elicits distinct pro-inflammatory and matrix-remodeling responses in tenocytes while promoting early neurite growth in sensory neurons. These findings suggest netrin-1 as a key modulator of tendon inflammation, matrix turnover, and peripheral nerve plasticity following injury. Full article

Background: Arthroscopic rotator cuff repair faces high retear risks in multi-tendon injuries due to insufficient biological healing; leukocyte-rich PRP may enhance tendon–bone integration through inflammatory modulation and growth factor release. Methods: Four databases including PubMed, Embase, Cochrane Library, and Web of Science were searched until March 2025. Literature screening, quality evaluation, and data extraction were performed according to inclusion and exclusion criteria. GRADE was used to grade the strength of the evidence and the results. Results: The main finding of this study was that leukocyte-rich platelet-rich plasma combined with arthroscopic surgery for rotator cuff injuries can improve the Constant Score (MD = 1.13, 95% CI: 0.19, 2.07, p = 0.02, I² = 47%), American Shoulder and Elbow Surgeons score (MD = 6.02, 95% CI: 4.67, 7.36, p < 0.01, I² = 0%), and University of California, Los Angeles score (MD = 1.20, 95% CI: 0.34, 2.06, p < 0.01, I² = 0%) of patients with rotator cuff tear after treatment, and reduce the postoperative Visual Analog Scale score (MD = −0.62, 95% CI: −1.16, −0.08, p = 0.02, I² = 83%) of patients. However, there were no statistical differences regarding the Simple Shoulder Test (MD = 0.08, 95% CI: −0.23, 0.39, p = 0.61, I² = 5%). Conclusions: Based on current evidence, the use of LR-PRP in arthroscopic rotator cuff repair could lessen postoperative pain and improve postoperative functional scores in individuals with rotator cuff injuries. Full article

Periodization is a concept of systematic progression in training and rehabilitation. The rehabilitation literature, however, is scarce, with information about optimally designing resistance training programs based on periodization principles for injured athletes. This periodization model—reverse linear neuro periodization—is a model proposed for the long-term rehabilitation needed after an arthroscopic rotator cuff repair. With recent evidence supporting neural contributions to shoulder injuries and the rate of recovery, rehabilitation protocols may benefit from incorporating approaches that target the sensorimotor system. Integrating motor learning principles (external focus and differential learning) and new technologies (virtual reality, laser pointers, stroboscopic glasses) may bolster current shoulder rehabilitation protocols and improve patient recovery times and outcomes. Such an understanding allows well-informed sport rehabilitation specialists to better bridge the gap between the preparation for competition widely used by coaches and the treatment of injuries that may occur. Full article

Background: Statins are essential for managing cholesterol levels but can induce musculoskeletal side effects, including tendinopathy of the shoulder. Rotator Cuff Disease (RCD) is one of the most common shoulder tendinopathy. The aim of the present study is to report a clinical case of statin-induce RCD after performing a systematic review on the subject. Materials and Methods: We performed a systematic review of the literature and report the case of a 49-year-old man with statin-induced RCD treated with a personalized individual rehabilitation project (IRP) (steroid and HA injections, mesotherapy, and therapeutic exercise) to investigate the relationship between statins and shoulder tendinopathy. The review followed PRISMA guidelines (2020 version), searching PubMed, Web of Science, and SCOPUS. Results: Out of a total of 217 articles, three cohort studies were suitable for our review. Conflicting evidence emerged regarding the association between statins and shoulder tendinopathy from the included papers. The case report describes a patient who experienced RCD after increasing atorvastatin dosage, with symptoms improving after dose reduction and a multimodal personalized IRP. Conclusions: Statins may contribute to tendon injury by altering the extracellular matrix and cell membrane integrity. While tendinopathy and statin relation is still under discussion, clinicians should monitor patients for tendinopathy and consider switching to alternative treatments in case symptoms arise. The case report demonstrated the successful management of statin-induced RCD with a multimodal personalized IRP. Further research is needed to clarify the relationship between statins and shoulder tendinopathy. Early diagnosis and appropriate personalized management are crucial for optimizing patient outcomes. Full article

Objectives: Shoulder injury related to vaccine administration (SIRVA), previously observed with influenza vaccines, has gained clinical significance with widespread COVID-19 vaccination. However, few studies correlate vaccine types and demographic factors with the MRI findings of SIRVA. This study aimed to evaluate MRI findings of SIRVA following COVID-19 vaccination and assess associations with vaccine type and patient characteristics. Methods: A retrospective cohort study was conducted on 35 patients with new-onset shoulder complaints within six weeks of COVID-19 vaccination between May 2021 and May 2022. MRI findings suggestive of SIRVA were reviewed, including subacromial bursitis, rotator cuff tears, and adhesive capsulitis. Demographic data, vaccine type, clinical symptoms, and treatments were collected. Follow-up interviews (1–30 September 2024) assessed symptom persistence and vaccine hesitancy. Descriptive statistics and Chi-square tests were used to explore associations. Results: Of the 35 patients (mean age 53.6 ± 9.0 years; 54.3% female), subacromial bursitis was the most common MRI finding (89.5%), followed by tendonitis (47.4%) and adhesive capsulitis (36.8%). Tendonitis correlated with older age (p = 0.024) and AstraZeneca vaccination (p = 0.033). Subacromial bursitis was linked to female sex (p = 0.013) and higher BMI (p = 0.023). Adhesive capsulitis was associated with receiving the Sinopharm vaccine (p = 0.029). Persistent symptoms (22.9%) were more common in younger patients, women, and those with right-sided injections. Conclusions: SIRVA following COVID-19 vaccination showed different MRI patterns associated with female sex, higher BMI, and vaccine type. Awareness of these patterns may expedite recognition of COVID-19-associated SIRVA in routine practice. Full article

Background/Objectives: Rotator cuff tears are a prevalent cause of shoulder pain and functional impairment. Full-thickness tears often require surgical intervention, but managing such injuries can be challenging, particularly when complete anatomical repair is unattainable. Bioinductive implants have emerged as an innovative adjunct to enhance tendon healing and regeneration. Methods: This case report details the partial repair of a full-thickness rotator cuff tear in a 66-year-old woman, augmented with a bioinductive implant. Postoperative recovery was monitored through clinical examinations, MRI, and kinematic analysis at 3 and 6 months. Results: The findings suggest that bioinductive implants may offer a promising strategy for managing complex rotator cuff tears, particularly when complete repair is not feasible. The patient reported improvement in function and pain reduction. Conclusions: The use of bioinductive implants showed promising results, promoting tendon regeneration and improving functional outcomes. Future research should explore patient selection criteria and the long-term effectiveness of this strategy. Full article

Background and Objectives: Shoulder pain, mainly involving rotator cuff tears, is a common type of musculoskeletal pain that significantly impairs quality of life. Arthroscopic rotator cuff repair has become the gold standard for treating symptomatic, full-thickness rotator cuff tears. Double-row repair techniques are widely used because of their superior fixation and healing results. However, fewer implants may reduce treatment costs and raise questions about the impact on clinical outcomes and re-tear rates. This study compares the functional outcomes and re-tear rates of two transosseous-like double-row repair techniques: one anchor and one push lock (Group 1), and two anchors and two push locks (Group 2). Materials and Methods: A prospective, randomized, single-blind study was conducted on 53 patients undergoing arthroscopic repair for crescent-shaped rotator cuff tears (3–5 cm). Before surgery and 24 months after surgery, patients were evaluated for shoulder function using Constant–Murley scores and shoulder abduction angles. MRI was used to assess re-tear rates. Results: Both groups showed significant postoperative improvement in Constant scores (Group 1: 84.1; Group 2: 84.0; p > 0.05). Re-tear rates were slightly higher in Group 1 (23.1%) than in Group 2 (18.5%), but this was not statistically significant (p > 0.05). Shoulder abduction angles improved similarly between groups, with no significant difference in outcome. Despite higher costs and longer operative times, the two-anchor technique provided more stable fixation, but its functional outcomes were comparable to the single-anchor method. Conclusions: Using fewer implants in a double-row repair provides comparable functional outcomes and re-tear rates, and offers surgeons a cost-effective alternative, especially at the beginning of their learning curve. However, the two-anchor technique may be more beneficial in cases requiring improved mechanical stability. These findings provide valuable information to balance cost and effectiveness in rotator cuff repair. Full article

Background/Objectives: The repetitive overhead throwing of baseball stresses the posterior shoulder, including the rotator cuff and capsule, causing stiffness, tissue thickening, and dysfunction. Previous studies on collegiate baseball players have linked these changes to glenohumeral internal rotation deficits, pain, and injuries. However, these studies primarily used acoustic radiation force impulse-based shear wave elastography (SWE), which has limitations, including tissue heating and lack of portability. The acute effects of pitching on infraspinatus (ISP) muscle elasticity in high school pitchers remain unclear. Therefore, this study aimed to evaluate the acute impact of pitching on ISP muscle elasticity in high school baseball pitchers using continuous SWE (C-SWE), which is a safer and more portable method. The relationship between ISP muscle elasticity and pitching load was also examined. Methods: ISP muscle shear wave velocity (SWV), shoulder range of motion, and strength were evaluated in high school baseball pitchers. The participants were categorized into pitching and non-pitching groups based on whether they pitched with full effort on the day of their medical checkup. C-SWE was used to assess ISP muscle elasticity. Results: The pitching group had considerably higher ISP muscle SWV on the dominant side than the non-pitching group (p = 0.008). A significant positive correlation was observed between pitch and ISP muscle SWV (r = 0.467, p = 0.003). Conclusions: Repetitive pitching acutely increases ISP muscle stiffness in high school pitchers, contributing to posterior shoulder tightness. C-SWE is a safe and practical method for assessing tissue elasticity and developing injury prevention strategies. Full article

Background/Objectives: Many patients evaluated by shoulder specialists suffer from intractable pain, neuropathy, and weakness. The pectoralis minor (PM) remains the only scapula muscle to receive lower trunk (C8-T1) input. We propose a novel syndrome: the Human Disharmony Loop. This model portrays how this unique PM innervation causes scapular dyskinesia, which deranges the anatomy of the upper limb girdle and produces a refractory symptom complex of pain, neuropathy, and weakness. We hypothesize that certain patients with historically intractable symptoms of the upper limb girdle may benefit from PM tenotomy. Methods: Ten patients of diverse etiologies presented with a similar constellation of complaints. The patients included a female athlete, a female with macromastia, a male bodybuilder, and patients with post-radiation breast cancer, post-operative shoulder arthroplasty, interscalene block injury, cervical spine disease, persistent impingement after rotator cuff repair, direct traction injury, and occupational disorder. All patients exhibited coracoid tenderness, scapula protraction with internal rotation and anterior tilt, and pain involving the neck, shoulder, and upper back. The patients demonstrated varying degrees of arm neuropathy, subacromial impingement, and occipital headaches. The patients failed all prior treatments by multiple subspecialists, including surgery. Each patient underwent isolated open PM tenotomy. Results: In all ten patients, PM tenotomy substantially reduced shoulder, upper back, and neck pain, cleared concomitant neuropathy, restored full motion, and eradicated occipital headaches. The response to surgery was rapid, dramatic, and durable. Conclusions: The unique asymmetric neurologic innervation to the sole ventral stabilizer of the scapula, the pectoralis minor, predisposes the human shoulder to neurologic and musculoskeletal imbalance. This produces the Human Disharmony Loop: a clinical syndrome spanning from the neck to the fingertips, with chronic pain, neuropathy, and weakness. These challenging patients may benefit dramatically from isolated PM tenotomy. Full article

Background: Over the season, competitive swimmers experience a progressive imbalance in rotator cuff strength, predisposing them to a significant risk factor for a swimmer’s shoulder injury. Objectives: Verify the effectiveness of two 12-week preventive programs on the shoulder rotators’ peak torque and conventional/functional ratios. Design: A care provider- and participant-blinded, parallel, randomized controlled trial with three groups. Participants: Competitive swimmers aged 16 to 35 years with no prior clinical issues related to their shoulders. Interventions: Twice a week, over 12 weeks, the two experimental groups performed five exercises where the only difference was executing the program with weights or elastic bands, and the control group performed a sham intervention. Main outcome measures: The concentric and eccentric peak torque of the internal and external rotators of the dominant shoulder were assessed before and after the intervention using an isokinetic dynamometer Biodex System 3, at 60°/s, 120°/s, and 180°/s. Results: Among the experimental groups, only one test indicated a reduction (p ≤ 0.05) in rotator peak torque, while the control group showed a decrease (p ≤ 0.05) in five tests. Swimmers who completed the prevention programs demonstrated less imbalance in conventional/functional ratios than controls. Conclusions: Implementing a 12-week preventive program minimizes the progressive shoulder rotational imbalance over the season in competitive swimmers. Clinical Trial Registration number: NCT06552585. Full article

This paper proposes an AI-based diagnostic method using MRI images for rotator cuff injuries to assist in treatment by segmenting tear areas and assessing tear severity. A multi-model deep learning network based on Unet + FPN architecture was developed to automatically segment rotator cuff injury images and determine tear grades. A dataset of 376 patients with 5640 images was used for training, with an additional 94 patients and 1410 images reserved for testing. To optimize segmentation, a tailored matching strategy was applied, achieving an Intersection over Union (IoU) of 0.79 ± 0.01 and a Dice coefficient of 0.75 ± 0.01, indicating high accuracy in segmenting tear areas. For tear severity indicators, the accuracy of estimating retraction (ER) reached 0.92 ± 0.02, and the accuracy of estimating stop tear width (ESTW) reached 0.79 ± 0.01. As the first AI algorithm specifically developed for diagnosing rotator cuff injuries, this platform demonstrates promising accuracy in both tear segmentation and severity assessment, aiming to support doctors in providing efficient, accurate diagnoses of rotator cuff tears. Full article

Background: This systematic review examines the clinical presentations and prevalence of scapulohumeral periarthritis (SP) by synthesizing the relevant literature from open-access articles from international databases (Medline, Pedro, and EBSCO). Methods: Keywords guiding the review included ‘scapulohumeral periarthritis’, ‘clinical forms’, ‘incidence’, ‘impingement syndrome, ‘calcifying tendinitis’, ‘bicipital tendonitis’, ‘shoulder bursitis’, ‘adhesive capsulitis or frozen shoulder’, ‘rotator cuff tears’, ‘functional assessment’, and ‘clinical trials’. Eligible studies included randomized controlled trials, nonrandomized controlled trials, cross-sectional studies, and review articles published between 1972 and 2024. Results: Our screening identified 2481 initial articles, of which 621 were further reviewed for eligibility resulting in 107 articles that met the relevance criteria. The findings highlight six distinct clinical forms of SP, such as partial rotator cuff tears and calcific tendinitis, each characterized by specific pathological features and prevalence patterns. Key factors contributing to SP include injuries, scapular instability, acromion deformities, and degenerative rotator cuff changes. Functional assessments, including the Neer, Hawkins, Pain Arc, and Yocum tests, demonstrated diagnostic value in distinguishing SP from other shoulder conditions. Conclusions: By comprehensively analyzing the clinical forms, functional assessment methods, and prevalent lesions of SP, functional testing can improve early diagnosis and guide personalized physiotherapy protocols for optimal rehabilitation in the physiotherapist’s practice. Full article