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Nathani HR, Ramteke SU, Jaiswal PR. Physiotherapeutic Management for Acromioclavicular Joint Sprain With Volar Intercalated Segment Instability at the Wrist: A Case Report. Cureus 2024; 16:e58399. [PMID: 38756306 PMCID: PMC11097279 DOI: 10.7759/cureus.58399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Among sports enthusiasts and young individuals, acromioclavicular (AC) joint injuries are highly prevalent. In this, we discussed the comprehensive assessment and management of a 22-year-old male patient who is a student by occupation and a recreational badminton player who presented with left shoulder and wrist pain following a road traffic accident. The study highlights the clinical findings, diagnostic assessment, and therapeutic interventions for the patient with volar intercalated segment instability and a grade 1 AC joint sprain. The methodology involves a case report of the patient's clinical evaluation, including range of motion, manual muscle testing, and diagnostic imaging. The patient was managed conservatively with physiotherapy interventions, including Mulligan's movement with mobilization, cryotherapy, light amplification by stimulated emission of radiation, and progressive exercises. The results of the study demonstrate the successful implementation of a multidisciplinary conservative management approach for alleviating pain, restoring function, and promoting optimal recovery for the patient. The implications of the study underscore the significance of tailored physical therapy rehabilitation in the management of AC joint sprains and wrist instabilities.
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Affiliation(s)
- Harsh R Nathani
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Swapnil U Ramteke
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Pratik R Jaiswal
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Effect of intraarticular pressure on glenohumeral kinematics during a simulated abduction motion: a cadaveric study. BMC Musculoskelet Disord 2023; 24:105. [PMID: 36750786 PMCID: PMC9906871 DOI: 10.1186/s12891-023-06127-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 01/02/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND The current understanding of glenohumeral joint stability is defined by active restrictions and passive stabilizers including naturally-occurring negative intraarticular pressure. Cadaveric specimens have been used to evaluate the role of intraarticular pressure on joint stability, although, while the shoulder's negative intraarticular pressure is universally acknowledged, it has been inconsistently accounted for. HYPOTHESIS During continuous, passive humeral abduction, releasing the native intraarticular pressure increases joint translation, and restoring this pressure decreases joint translations. STUDY DESIGN Descriptive Laboratory Study. METHODS A validated shoulder testing system was used to passively abduct the humerus in the scapular plane and measure joint translations for seven (n = 7) cadaveric specimens. The pressure within the glenohumeral joint was measured via a 25-gauge needle during passive abduction of the arm, which was released and subsequently restored. During motion, the rotator cuff muscles were loaded using stepper motors in a force feedback loop and electromagnetic sensors were used to continuously measure the position of the humerus and scapula. Joint translation was defined according to the instant center of rotation of the glenohumeral head according to the recommendations by the International Society of Biomechanics. RESULTS Area under the translation versus abduction angle curve suggests that releasing the pressure within the capsule results in significantly less posterior translation of the glenohumeral head as compared to intact (85-90˚, p < 0.05). Posterior and superior translations were reduced after 70˚ of abduction when the pressure within the joint was restored. CONCLUSION With our testing system employing a smooth continuous passive motion, we were able to show that releasing intraarticular pressure does not have a major effect on the path of humeral head motion during glenohumeral abduction. However, both violating the capsule and restoring intraarticular pressure after releasing alter glenohumeral translations. Future studies should study the effect of simultaneous external rotation and abduction on the relationship between joint motion and IAP, especially in higher degrees of abduction. CLINICAL RELEVANCE Thoroughly simulating the glenohumeral joint environment in the cadaveric setting may strengthen the conclusions that can be translated from this setting to the clinic.
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Kurata S, Inoue K, Shimizu T, Nagashima M, Murayama H, Kawamura K, Omokawa S, Mahakkanukrauh P, Tanaka Y. Acromioclavicular joint instability on cross-body adduction view: the biomechanical effect of acromioclavicular and coracoclavicular ligaments sectioning. BMC Musculoskelet Disord 2022; 23:279. [PMID: 35321711 PMCID: PMC8943985 DOI: 10.1186/s12891-022-05245-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background The acromioclavicular (AC) and coracoclavicular (CC) ligaments are important stabilizers of the AC joint. We hypothesized that AC and trapezoid ligament injuries induce AC joint instability and that the clavicle can override the acromion on cross-body adduction view even in the absence of conoid ligament injury. Accordingly, we investigated how sectioning the AC and CC ligaments contribute to AC joint instability in the cross-body adduction position. Methods Six fresh-frozen cadaveric shoulders were used in this study, comprising five male and one female specimen, with a mean age of 68.7 (range, 51–87) years. The left side of the trunk and upper limb, and the cervical and thoracic vertebrae and sternum were firmly fixed with an external fixator. The displacement of the distal end of the clavicle relative to the acromion was measured using an electromagnetic tracking device. We simulated AC joint dislocation by the sequential resection of the AC ligament, AC joint capsule, and CC ligaments in the following order of stages. Stage 0: Intact AC and CC ligaments and acromioclavicular joint capsule; stage 1: Completely sectioned AC ligament, capsule and joint disc; stage 2: Sectioned trapezoid ligament; and stage 3: Sectioned conoid ligament. The superior clavicle displacement related to the acromion was measured in the horizontal adduction position, and clavicle overriding on the acromion was assessed radiologically at each stage. Data were analyzed using a one-way analysis of variance and post-hoc tests. Results Superior displacement was 0.3 mm at stage 1, 6.5 mm at stage 2, and 10.7 mm at stage 3. On the cross-body adduction view, there was no distal clavicle overriding at stages 0 and 1, and distal clavicle overriding was observed in five cases (5/6: 83%) at stage 2 and in six cases (6/6: 100%) at stage 3. Conclusion We found that AC and trapezoid ligament sectioning induced AC joint instability and that the clavicle could override the acromion on cross-body adduction view regardless of conoid ligament sectioning. The traumatic sections of the AC and trapezoid ligament may lead to high grade AC joint instability, and the distal clavicle may subsequently override the acromion.
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Affiliation(s)
- Shimpei Kurata
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijoutyou, Kashihara City, Nara, 634-5821, Japan.
| | - Kazuya Inoue
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijoutyou, Kashihara City, Nara, 634-5821, Japan
| | - Takamasa Shimizu
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijoutyou, Kashihara City, Nara, 634-5821, Japan
| | - Mitsuyuki Nagashima
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijoutyou, Kashihara City, Nara, 634-5821, Japan
| | - Hirakazu Murayama
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijoutyou, Kashihara City, Nara, 634-5821, Japan
| | - Kenji Kawamura
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijoutyou, Kashihara City, Nara, 634-5821, Japan
| | - Shohei Omokawa
- Department of Hand Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Pasuk Mahakkanukrauh
- Department of Anatomy Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Excellence Center in Osteology Research and Training Center (ORCT), Chiang Mai University, Chiang Mai, Thailand
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijoutyou, Kashihara City, Nara, 634-5821, Japan
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Figueras JH, Sabbagh RS, Thomson CG, Shah NS, Kuechly HA, Mennenga A, Grawe B. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac201. [PMID: 35592451 PMCID: PMC9113453 DOI: 10.1093/jscr/rjac201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
We report a 45-year-old man who presented with a rotator cuff tear and scapular dyskinesis of his left shoulder and underwent a pectoralis major split transfer with an allograft to the inferior border of his scapula. The patient reported significant improvement in shoulder function and decreased severity of his scapular dyskinesis. Combined arthroscopic rotator cuff repair and allograft scapula stabilization is a novel technique for the unusual clinical presentation reported in this case report. To the best of our knowledge, this is the first reported surgical management of a patient with rotator cuff repair and non-palsy-related scapular dyskinesis.
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Affiliation(s)
- Jorge H Figueras
- Correspondence address. Department of Orthopaedics and Sports Medicine, 231 Albert Sabin Waym, Cincinnati, OH 45267-0212, USA. Tel: (305) 401–9054; Fax: (513) 558–2220; E-mail:
| | - Ramsey S Sabbagh
- Department of Orthopaedic Surgery and Sports Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Cameron G Thomson
- Department of Orthopaedic Surgery and Sports Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nihar S Shah
- Department of Orthopaedic Surgery and Sports Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Henry A Kuechly
- Department of Orthopaedic Surgery and Sports Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ashley Mennenga
- Department of Orthopaedic Surgery and Sports Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brian Grawe
- Department of Orthopaedic Surgery and Sports Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Monoplanar horizontal instability of the acromioclavicular joint: case report and stabilization surgical technique. JSES Int 2020; 5:194-197. [PMID: 33681837 PMCID: PMC7910732 DOI: 10.1016/j.jseint.2020.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Williamson PM, Hanna P, Momenzadeh K, Lechtig A, Okajima S, Ramappa AJ, DeAngelis JP, Nazarian A. Effect of rotator cuff muscle activation on glenohumeral kinematics: A cadaveric study. J Biomech 2020; 105:109798. [PMID: 32423544 DOI: 10.1016/j.jbiomech.2020.109798] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 12/20/2022]
Abstract
Healthy shoulder function requires the coordination of the rotator cuff muscles to maintain the humeral head's position in the glenoid. While glenohumeral stability has been studied in various settings, few studies have characterized the effect of dynamic rotator cuff muscle loading on glenohumeral translation during shoulder motion. We hypothesize that dynamic rotator cuff muscle activation decreases joint translation during continuous passive abduction of the humerus in a cadaveric model of scapular plane glenohumeral abduction. The effect of different rotator cuff muscle activity on glenohumeral translation was assessed using a validated shoulder testing system. The Dynamic Load profile is a novel approach, based on musculoskeletal modeling of human subject motion. Passive humeral elevation in the scapular plane was applied via the testing system arm, while the rotator cuff muscles were activated according to the specified force profiles using stepper motors and a proportional control feedback loop. Glenohumeral translation was defined according to the International Society of Biomechanics. The Dynamic load profile minimized superior translation of the humeral head relative to the conventional loading profiles. The total magnitude of translation was not significantly different (0.805) among the loading profiles suggesting that the compressive forces from the rotator cuff primarily alter the direction of humeral head translation, not the magnitude. Rotator cuff muscle loading is an important element of cadaveric shoulder studies that must be considered to accurately simulate glenohumeral motion. A rotator cuff muscle activity profile based on human subject muscle activity reduces superior glenohumeral translation when compared to previous RC loading profiles.
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Affiliation(s)
- Patrick M Williamson
- Boston University, Mechanical Engineering Department, Boston, MA, USA; Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Philip Hanna
- Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kaveh Momenzadeh
- Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Aron Lechtig
- Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephen Okajima
- Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Arun J Ramappa
- Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Joseph P DeAngelis
- Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia.
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