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Occupation ratio and fatty infiltration are important parameters for evaluating patients with rotator cuff tears. We analyzed the occupation ratio using a deep-learning framework and studied the fatty infiltration of the supraspinatus muscle using an automated region-based Otsu thresholding technique. To calculate the amount of fatty infiltration of the supraspinatus muscle using an automated region-based Otsu thresholding technique. The mean Dice similarity coefficient, accuracy, sensitivity, specificity, and relative area difference for the segmented lesion, measuring the similarity of clinician assessment and that of a deep neural network, were 0.97, 99.84, 96.89, 99.92, and 0.07, respectively, for the supraspinatus fossa and 0.94, 99.89, 93.34, 99.95, and 2.03, respectively, for the supraspinatus muscle. The fatty infiltration measure using the Otsu thresholding method significantly differed among the Goutallier grades (Grade 0; 0.06, Grade 1; 4.68, Grade 2; 20.10, Grade 3; 42.86, Grade 4; 55.79, p  < 0.0001). The occupation ratio and fatty infiltration using Otsu thresholding demonstrated a moderate negative correlation ( ρ  = − 0.75, p  < 0.0001). This study included 240 randomly selected patients who underwent shoulder magnetic resonance imaging (MRI) from January 2015 to December 2016. We used a fully convolutional deep-learning algorithm to quantitatively detect the fossa and muscle regions by measuring the occupation ratio of the supraspinatus muscle. Fatty infiltration was objectively evaluated using the Otsu thresholding method. The proposed convolutional neural network exhibited fast and accurate segmentation of the supraspinatus muscle and fossa from shoulder MRI, allowing automatic calculation of the occupation ratio. Quantitative evaluation using a modified Otsu thresholding method can be used to calculate the proportion of fatty infiltration in the supraspinatus muscle. We expect that this will improve the efficiency and objectivity of diagnoses by quantifying the index used for shoulder MRI.

Background General scapular exercises have been included in traditional postoperative rehabilitation for rotator cuff tears, but patients with concomitant scapular dyskinesia do not have identical scapular muscle imbalances, and general scapular exercises make it difficult to improve scapular movement. We hypothesized that identifying weak scapular muscle groups and strengthening training would improve scapular movement. Methods A total of 60 rotator cuff tear patients with scapular dyskinesia were included in the study, 20 in the experimental group and 40 in the control group. Patients in the control group received traditional rehabilitation following rotator cuff repair, while patients in the experimental group performed additional selective scapular muscle rehabilitation exercises. Constant-Murley Score (CMS), shoulder mobility, VAS scores, SF-12 scores, and scapular motion were assessed in both groups at 16 weeks postoperatively. Results At 16-week follow-up, the experimental group showed better CMS (87.2 ± 4.4 vs. 83.9 ± 4.8) and shoulder anteflexion (137 ± 13.0 vs. 127.9 ± 12.2°) and abduction mobility (133.1 ± 15.4 vs. 121.4 ± 13.8°) compared to the control group. The experimental group had better improvements in scapular upward rotation (42.8 ± 11.7 vs. 35.3 ± 9.6°) and anterior tilt (12.9 ± 4.2 vs. 6.4 ± 2.0°) during shoulder anteflexion versus the control group. During shoulder abduction, the experimental group had better improvements in scapular anterior tilt (12.8 ± 3.3 vs. 9.1 ± 3.0°) versus the control group. Conclusions This study provides an additional exercise program targeting the scapular muscle groups for postoperative rehabilitation in rotator cuff tear patients with scapular dyskinesis. By identifying imbalanced muscles through electromyographic testing, and performing selective muscle strengthening exercises, better shoulder mobility and scapular motion performance can be achieved. Trial registration (Chinese Clinical Trial Registry ( https://www.chictr.org.cn ), ChiCTR2400087465, July 29, 2024, prospectively registered.)

The positive effect of platelet-rich plasma (PRP) on tendon metabolism has been extensively investigated and proven in vitro. Additionally, in vivo animal studies have correlated the application of PRP with the enhancement of tenocyte anabolic activity in the setting of tendon degeneration. However, less is known about its in vivo effect on human tendon biology. The purpose of the current prospective randomized comparative study was to evaluate the effect of PRP on torn human supraspinatus tendon. Twenty consecutive eligible patients with painful and magnetic resonance imaging (MRI)-confirmed degenerative supraspinatus tendon tears were randomized in a one-to-one ratio into two groups. The patients in the experimental group (n = 10) underwent an ultrasound-guided autologous PRP injection in the subacromial space 6 weeks before the scheduled operation. In the control group (n = 10), no injection was made prior to surgery. Supraspinatus tendon specimens were harvested from the lateral end of the torn tendon during shoulder arthroscopy and were evaluated under optical and electron microscopy. In the control group, a mixed cell population of oval and rounded tenocytes within disorganized collagen and sites of accumulated inflammatory cells was detected. In contrast, the experimental group yielded abundant oval-shaped cells with multiple cytoplasmic processes within mainly parallel collagen fibers and less marked inflammation, simulating the intact tendon structure. These findings indicate that PRP can induce microscopic changes in the ruptured tendon by stimulating the healing process and can facilitate a more effective recovery.

Introduction Pain management and prevention of muscle atrophy are key rehabilitation challenges following arthroscopic rotator cuff repair (ARCR). Despite the potential muscle atrophy-reducing and analgesic effects of neuromuscular electrical stimulation (NMES), evidence supporting its use in post-ARCR rehabilitation remains limited. This study aimed to evaluate the clinical efficacy of home-based NMES intervention for promoting early functional recovery after ARCR. Methods A total of 63 ARCR patients were randomized into the NMES group ( n  = 32) and MENS (Micro-current electrical nerve stimulation) group ( n  = 31), both receiving a 6-week home-based intervention (5 sessions weekly, 30 min per session) following surgery. The NMES group used neuromuscular electrical stimulation equipment, while the MENS group used identical devices without current output. The primary outcome was the Constant-Murley Shoulder (CMS) score, with secondary outcomes including resting and active visual analog scale (VAS) pain scores, deltoid muscle thicknes, shoulder range of motion (ROM), muscle strength, and Tampa Scale for Kinesiophobia scores. Assessments were conducted preoperatively, at 6 weeks, and 3 months postoperatively. Results At 6 weeks postoperatively, the NMES group exhibited a significantly higher CMS than the MENS group (76.10 ± 9.43 vs. 71.22 ± 9.2 p  = 0.032), along with superior active pain relief (active VAS: 4.1 ± 0.9 vs. 3.4 ± 0.7 p  = 0.003), greater forward flexion ROM (151.7 ± 11.3 vs. 141.8 ± 13.6 p  = 0.003), and thicker deltoid muscle thickness (1.02 ± 0.06 vs. 0.91 ± 0.06 p  < 0.001). The NMES group also demonstrated lower TSK scores (31.06 ± 6.69 vs. 35.42 ± 7.76 p  = 0.020) and greater adductor strength (40.9 ± 16.7 vs. 33.5 ± 12.2 p  = 0.048). By 3 months postoperatively, intergroup differences persisted only in abductor ROM, muscle strength, and deltoid thickness, with no significant disparities in other measured indices. Conclusions Home-based NMES effectively accelerates functional recovery, enhances pain management, and mitigates kinesiophobia within 6 weeks post-ARCR, with partial maintenance of these benefits at the 3-month follow-up. This intervention offers a safe adjunctive strategy for early rehabilitation, particularly suited to patients requiring rapid functional restoration; however, long-term efficacy remains to be confirmed.To evaluate the acceptability of MyCheck for asymptomatic sexually transmissible infections (STIs) testing. Trial registration (Chinese Clinical Trial Registry ( https://www.chictr.org.cn ), No. ChiCTR2400088194, 13/08/2024)

Background Degenerative rotator cuff tears are common and are often treated with surgical repair. Randomised trials have not shown a clear advantage to surgery over non-surgical treatment, but there have been no published placebo-controlled trials investigating rotator cuff repair. This study aims to compare arthroscopic shoulder surgery with rotator cuff repair to surgery without rotator cuff repair (placebo) for improving shoulder pain and function in people with shoulder pain and full-thickness degenerative rotator cuff tears. Methods The study is a multicentre two-parallel arm, blinded, individually randomised controlled trial (RCT). Participants will be people aged 40–75 years (inclusive) with more than 6 months of shoulder pain, a degenerative (non-traumatic) full thickness rotator cuff tear 1 to 4 cm in length for whom surgery is recommended and repair of the tear is the main reason for surgery. The intervention is arthroscopic surgery (including—as indicated—bursectomy, debridement, acromioclavicular joint resection, acromioplasty and biceps tenodesis or tenotomy) with rotator cuff repair. The control is the same arthroscopic shoulder surgery without rotator cuff repair. Participants will be randomised to cuff repair or no cuff repair in a 1:1 ratio intra-operatively, after all other surgical procedures have been performed. Participants, follow-up surgeons, physiotherapists, study staff and statisticians will be blinded. Post-surgical rehabilitation will be usual care for rotator cuff repair in both groups. The primary outcome will be shoulder pain and function measured using the Western Ontario Rotator Cuff Index at 6 months post-surgery. Discussion The ARC trial will provide low bias evidence on a common surgical procedure: rotator cuff repair for degenerative tears. Trial registration The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620000789965) on 5 August 2020 and the WHO International Clinical Trials Registry Platform (universal trial number U1111-1251-6599).

Purpose Kinesiophobia (fear of movement) is a major limiting factor in the return to pre-injury sport level after surgery of rotator cuff tears. The study aims to gain insights into how kinesiophobia affects shoulder pain and function after the repair of full-thickness rotator cuff tears. Methods A prospective study was conducted to evaluate patients who underwent rotator cuff repair between January 2019 and December 2019 in our institution. The patients were divided into a trial group with a high kinesiophobia (Tampa Scale for Kinesiophobia [TSK], TSK > 37) and a control group with a low kinesiophobia (TSK ≤ 37). The indicators of interest included the Constant-Murley scores, numerical rating scale (NRS), visual analogue scale (VAS), Oxford Shoulder Score (OSS), and the American shoulder and elbow score (ASES), shoulder function and strength, and range of motion (ROM) at 3 days, 6 weeks, and 12 months after repair of full-thickness rotator cuff tears. Results In total, 49 patients who underwent repair of full-thickness rotator cuff tears were enrolled, which was divided into a trial group involving 26 patients (mean TSK 52.54) and a control group involving 23 patients (mean TSK 33.43). There were no statistically significant differences in basic information such as age, gender, and length of stay in the two groups. The preoperative and early postoperative functional scores and the Tampa Scale for Kinesiophobia were statistically significant differences between the two groups. However, long-term postoperative follow-up showed no statistically significant difference in ASES, and Constant-Murley scores, OSS, and VAS scores between the two groups as the kinesiophobia changed from positive to negative. Conclusion Degree of kinesiophobia reduced during post-operative rehabilitation of rotator cuff repair patients, but high kinesiophobia is still present in a large portion of the patients after rotator cuff repair. Patients after rotator cuff repair will benefit from early recognition and prevention of kinesiophobia.

Background Massive degenerative rotator cuff tears (MRCTs) represent a persistent challenge in shoulder surgery. While arthroscopic rotator cuff repair (ARCR) remains a widely accepted treatment with good functional outcomes, it is associated with a risk of retear and progression to cuff tear arthropathy. Reverse shoulder arthroplasty (RSA) has emerged as a viable alternative, particularly in cases where the reparability of the cuff is uncertain, offering pain relief and functional improvement. However, the optimal treatment approach for repairable MRCT in patients aged 60 to 80 years remains debated. This trial aims to assess whether RSA provides non-inferior outcomes to ARCR in patients with degenerative MRCTs, with a particular focus on function, pain, and quality of life. Methods This is a prospective, randomized, controlled, non-inferiority trial. A total of 145 patients with symptomatic, repairable MRCT will be enrolled and randomized in a 1:1 ratio to undergo either ARCR or RSA. The primary outcome is the American Shoulder and Elbow Surgeons (ASES) score at 24 months postoperatively. Secondary outcomes include ASES at 6 weeks and 6 months; Visual Analog Scale (VAS) for pain; Single Assessment Numeric Evaluation (SANE); Constant score; range of motion (ROM) in flexion, extension, and internal/external rotation; repair integrity (ultrasound for ARCR, radiographs for RSA); and complication rates. PROMs will be assessed at baseline, 1.5, 6, and 24 months. All adverse events and complications will be systematically recorded. Discussion This trial will provide robust comparative data to assess whether RSA is non-inferior to ARCR at two years postoperatively in terms of shoulder function and patient-reported outcomes in patients with repairable MRCT. The results aim to support evidence-based decision-making in clinical practice. Trial registration The protocol was approved by the Ethics Committee Board (CCER 2023–00111) in March 2023 and by ClinicalTrial.gov (NCT05807854).

Treatment of rotator cuff (RTC) tears commonly involves manual therapy, exercise, and injection methods. These treatments are typically administered together as components of a physical therapy intervention. However, it is not known which intervention is more effective. The objective of this study was to examine the impact of mobilization with movement (MWM) mobilization, a technique from Mulligan approaches, and corticosteroid (CS) injection on pain, functionality, and proprioception in cases of RTC tears. This was a single-blinded randomized clinical trial. Participants with RTC tears (n = 60) were divided into Mulligan mobilization (MM) and CS groups. The participants in the MM group performed mobilization with movement and a conventional exercise program; the CS group received a CS injection in addition to conventional exercises. The Visual Analog Scale, The Disabilities of the Arm, Shoulder, and Hand questionnaire, active range of motion (AROM), and joint position sense (JPS) were evaluated. The outcomes were analyzed using effect size, minimum clinically important difference, minimal detectable change, Wilcoxon test, and Mann-Whitney U test. Both groups significantly improved in all measured outcomes at 3 weeks. The MM group showed significantly better (p < 0.05, Cohen d range 0.82-3.2) results in pain, AROM (Flexion, abduction, extension, external rotation, internal rotation), and proprioception (30° and 60° of flexion and abduction). Between-group differences in AROM were also clinically meaningful as they exceeded their MDC90 and minimum clinically important difference values. Although both of these treatment methods may be successful in the short-term management of chronic RTC, the MM approach combined with conventional exercises seems to be a more effective approach for improving shoulder pain, function, and proprioception in this patient population. NCT05933382 •CS and MWM techniques are effective treatments for individuals with RTC tear.•The MWM technique has more advantages in the improvement of JPS and AROM.•The MWM technique, without side effects, could benefit those with RTC tear.

Objective Rotator cuff tears are one of the most common causes of chronic shoulder pain and disability. They significantly affect the quality of life. Reduced pain and improved function are the goals of conventional therapy, which includes relative rest, pain therapy, physical therapy, corticosteroid injections and surgical intervention. Tendons have a relative avascular nature; hence, their regenerative potential is limited. There is some clinical evidence that the application of autologous platelets may help to revascularize the area of injury in rotator cuff pathologies. Patients and methods This prospective randomized controlled study was done to evaluate the results of subacromial injection of platelet-rich plasma (PRP) versus corticosteroid injection therapy in 40 patients with symptomatic partial rotator cuff tears. All patients were assessed before injection, 6 weeks, 3 and 6 months after injection, using the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the Constant–Murley Score (CMS), the Simple Shoulder Test (SST) and a Visual Analog Scale (VAS) for pain. An MRI was performed before and 6 months after the injection for all the included patients and was graded on 0–5 scale. Results Both injection groups showed statistically significantly better clinical outcomes over time compared with those before injection. There was a statistically significant difference between RPP group and corticosteroid group 12 weeks after injection, regarding VAS, ASES, CMS and SST in favor of the RPP group. MRI showed an overall slight nonsignificant improvement in grades of tendinopathy/tear in both groups, however, without statistically significant differences between the two groups. Conclusion PRP injections showed earlier better results as compared to corticosteroid injections, although statistically significant better results after 6 months could not be found. Therefore, subacromial RPP injection could be considered as a good alternative to corticosteroid injection, especially in patients with a contraindication to corticosteroid administration. Level of evidence II.

Background Rotator cuff tear is a common cause of shoulder disability and results in patients predominantly complaining of pain and loss of motion and strength. Traumatic rotator cuff tears are typically managed surgically followed by ~ 20 weeks of rehabilitation. However, the timing and intensity of the postoperative rehabilitation strategy required to reach an optimal clinical outcome is unknown. Early controlled and gradually increased tendon loading has been suggested to positively influence tendon healing and recovery. The aim of this trial is therefore to examine the effect of a progressive rehabilitation strategy on pain, physical function and quality of life compared to usual care (that limits tendon loading in the early postoperative phase) in patients who have a rotator cuff repair of a traumatic tear. Methods The current study is a randomized, controlled, outcome-assessor blinded, multicenter, superiority trial with a two-group paralleled design. A total of 100 patients with surgically repaired traumatic rotator cuff tears will be recruited from up to three orthopedic departments in Denmark, and randomized to either a progressive early passive and active movement program or a limited early passive movement program (usual care). The primary outcome measure will be the change from pre-surgery to 12 weeks post-surgery in the Western Ontario Rotator Cuff Index questionnaire. Secondary outcomes include the Disabilities Arm, Shoulder and Hand questionnaire (DASH), range of motion, strength and tendon healing characteristics from ultrasound measurements at 12 months follow up. Discussion We hypothesized that patients who receive the progressive rehabilitation strategy will benefit more with respect to pain reduction, physical function and quality of life than those who receive care as usual. If this is confirmed our study can be used clinically to enhance the recovery of patients with traumatic rotator cuff tear. Trial registration ClinicalTrials.gov, NCT02969135 . Registered on 15 November 2016.